Member Application

Mancos Valley Historical Society
Post Office Box 465
Mancos Colorado, 81328

Name:    ___________________________________________________________

Address:  __________________________________________________________

Phone:   __________________   Email____________________________________

Levels of Membership: Please indicate level of membership.
All memberships are due for renewal in May of each year.

Please return top portion of this form with your check to address above.

	Gold: Life time. Includes a park bench with your name(s) engraved on a plaque.	$500
	Silver:	$300
	Bronze:	$100
	Business:	$50
	Family:	$25
	Single:	$15

Received: $_________  Check # _________ for _______________ Membership
which will expire on May 31, _______________

Deposited on_________________

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Please detach this portion of this form and keep for your records.

Mancos Valley Historical Society
Post Office Box 465
Mancos Colorado, 81328

Amount Paid: $____________       Check # __________

Meetings are held on the fourth Thursday of each month at 4:30 p.m. in the Fellowship Hall of the Mancos United Methodist Church at the corner of Grand Avenue & Oak Street.

Thank you!

Donna Watkins, Membership Chair
303-956-5656
DonnaWatkins.1021@gmail.com