Join the State Historical Society of North Dakota Foundation

Please enroll me as a member of the Foundation so that I may receive the benefits of membership while supporting the important work of the State Historical Society of North Dakota.

Name _____________________________________________________

Address____________________________________________________

City ___________________________ State ___________ Zip ________

Home Phone ________________________________________________

Membership Level:

Benefactor ($10,000)	Corporate ($500)	Family ($45*)
Director ($5,000)	Patron ($250)	Individual ($35*)
Founder ($1,000)	Sustaining ($100)	History's Trustee ($2002 pledge)

*Canadian membership is $42 individual; $52 family, which includes an annual $7 shipping and handling fee. All other foreign memberships are $50 individual; $60 family, including an annual $15 shipping and handling fee. All figures are US$.

Payment:

Check

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Card #________________________ Expiration Date ____________ VIN# _____

Name (as it appears on card)__________________________________________

Signature _________________________________________________________

Mail to:

State Historical Society of North Dakota Foundation
P.O. Box 1976
Bismarck, ND 58502-9921
Telephone: (701) 222-1966
Fax: (701) 328-3710