[Click the link below for a pdf file of this form]

FANHS Stockton Membership Form

Today's Date ______

NAME _______________________________________ PHONE# _________________

E-mail:____________________________

ADDRESS ______________________________________________________________

CITY, STATE, ZIP _______________________________________________________


Enclosed is $ _____  for _________________________________
                                 (membership category)
(If "Family" membership, please print names of underaged children living at home)

___ check here to give permission to be in Chapter Directory

Why I joined FANHS (or other information for our quarterly newsletter): _______________

_________________________________________________________________________


Area of interest/expertise:
__ archival record collection   __ lectures      __ oral history
__ photo collection                  __ research    __ videography
__ writing/newsletter              __ other (specify) ______________________

MEMBERSHIP CATEGORIES/RATES (New rates as of January 1, 2010)
Annual:  Student ..............$10.00      Lifetime: Individual........$300.00
              Senior (62+)........$10.00                    Family.............$350.00
              Individual............$30.00    10 Years: Individual ........$100.00
              Family.................$45.00                     Family.............$250.00


MAIL TO:
FANHS - Stockton Chapter, PO BOX 4616, Stockton CA 95204