MEMBERSHIP FORM

Please print, fill out, then mail completed form to:
GALVESTON HISTORICAL FOUNDATION
502 20th Street, Galveston, TX 77550
or fax to: 409-765-7851

Please start my membership to GALVESTON HISTORICAL FOUNDATION,
Texas’oldest historic preservation group.

Membership Levels Annual Fees
Student Membership
$30
Senior (60+)
$35
Individual
$50
Senior Couple
$60.00
Family Membership
$75.00
Patron $125.00
Benefactor
$250.00
Menard Society
$1,000.00

Date:______________________

Name:___________________________________________

Address:_________________________________________

City:_______________________________ State:_________

Zip Code:_________ Email address:_____________________

Daytime phone number: (___)__________________________

Name to be used on my membership card:
_________________________________________________

*Please list additional name(s) to be used on Family or Sr. Couple membership cards:
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________

__Enclosed is my check for______made payable to GHF;
OR Please charge to my:
__American Express __VISA
__Mastercard __Discover

Account No:_________________________ Exp: _________

Signature:________________________________________