White Pass Country Historical Society

P. O. Box 958

Packwood , WA 98361

(360) 494-4031

(e-mail: magaroutte@centurytel.net)

Membership Application

(Membership year: October 1 st through September 30 th )

New Member [__] Renewal [___]

I (we) would like to support the White Pass Country Historical Society by purchasing a membership as marked below (remittance enclosed):

(Annual Fee)

[ ] Individual $20.00

[ ] Couple $30.00

[ ] Student or Senior (60+) $15.00

[ ] Family with children under 18 $35.00

[ ] Business/ Organization $50.00

[ ] Life $250.00 (One Time Fee Per Person)

Name _____________________________________________________

Address ___________________________________________________

Phone _____________ City ________________State _____ZIP______

E-mail Address_____________________________________________

Date ______________ Signed _________________________________

(Membership card(s) will be provided)