APPLICATION FOR MEMBERSHIP         
       COLUSI COUNTY HISTORICAL SOCIETY 

NAME:             ____________________________

STREET ADDRESS:   _______________________

CITY:             _____________________________

STATE:            ______

ZIP:                  ______

HOME PHONE:       __________________________

EMAIL:            _____________________________

CHECK TYPE OF MEMBERSHIP DESIRED:

     ___  Family - $20

     ___  Benefactor - $40

     ___ Patron - $100

MAKE CHECK PAYABLE TO:

          Colusi County Historical Society

MAIL CHECK AND APPLICATION TO:

          C.C.H.S., P.O. Box 643, Willows, CA 95988

                                     "GETTING TO KNOW YOU" 

In order to know more about you and more about your interests in the history of Colusa, Glenn and Tehama Counties, we, the Directors of the Society, would appreciate your answers to the following questions:

Do you have roots in any of these counties?       __Yes     __No

If so, what counties and towns?
     ________________________________________________________
                
The names of your Colusi County ancestors and ther place of residence?         
     ________________________________________________________

Please list your specific areas of interest in the history of this area:
     ________________________________________________________

Do you have information about specific subjects or people in this area which you would like to share?

    ______________________________________________________

            (Cut and paste this form to your printer to print out the application.)