MINCO HISTORICAL SOCIETY 
                   MEMBERSHIP APPLICATION 

Minco Historical Society
P. O. Box 624
Minco, OK 73059 



NAME: ______________________________________________________________


ADDRESS: ___________________________________________________________


CITY, STATE, ZIP: __________________________________________________


E-MAIL ADDRESS: ____________________________________________________


MEMBERSHIP CATEGORIES 
ANNUAL, INDIVIDUAL:           $15
ANNUAL, BUSINESS/CORP.:       $25
LIFETIME, INDIVIDUAL         $200
LIFETIME, BUSINESS/CORP.     $300


CHECK THE FOLLOWING INTERESTS:
GENEALOGY:     ________
VOLUNTEERING:  ________
TOWN HISTORY:  ________
OTHER:         ________ LIST _____________________________________


Please print this form, complete, and mail to address shown above.