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