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.)