Kirkland Heritage Society Printable Membership Form

                  January 1 - December 31                                   Revised 03/02/2006
Check One: Membership Type: Amount
Senior / Student $20.00
Individual $25.00
Family $30.00
Supporting $100.00
Lifetime $1,000.00
Organization $100.00
Professional/Business $125.00
Corporate $250.00
Additional Donation $
Total Enclosed $
If your firm matches contributions, please attach the signed company form.  KHS is a 501(c)(3).

Checks to be made payable and mailed to:
Kirkland Heritage Society
203 Market Street
Kirkland, WA  98033  

Membership Chairperson (425)890-9058 lynette@kirklandheritage.com 

Resource Center Phone:  (425) 827-3446

Email: Help-line@kirklandheritage.com

Name_______________________________
Address_____________________________
City_________________State___Zip______
Home Phone _________________________
Email_______________________________

  Volunteer: 
 
Serve on a Standing Committee:
Archives and Collections
Communications
Blackberry Preserves Editor
Membership and Funding
Oral History and Research
Planning and Historic Sites
Programs and Education
Community Events & Activities
Work in the Resource Center