Application

 

I hereby apply for membership in the Placer County Historical Society
and enclose $________, annual dues for the year ______ or $________ for a Life Membership.

 

Mailing Address (Please Print)

 


NAME (Include all names for family membership)

 


NUMBER STREET

 


CITY or TOWN STATE ZIP

 

(         ) _____________________________

                             TELEPHONE

 

 

 

Please print, complete and mail with remittance to

 

PLACER COUNTY HISTORICAL SOCIETY

P.O. Box 5643

Auburn, California 95604

 

 

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