| Your Name . |
| Mailing Address . |
| City - State - Zip . |
| Telephone -
Home
Work . |
| E-Mail Address . |
| Your Areas of Interest (optional): . . . |
Please check the category of membership that you prefer
(Membership is for one year from the date your payment is received):
| _______ Heritage $5,000 and up | _______ Sponsor $250 |
| _______
Patron $1,000 and up |
_______ Friend $100 |
| _______ Sustaining $500 | _______ Family $50 |
| _______ Corporate $250 | _______ Single $35 |
| In addition, I want to contribute to: | |
| _______ St. Andrews Operations | _______ Jacksonville Historical Center |
| _______ JHS Archives | _______ Merrill House Restoration |
| Contributions are tax-deductable | TOTAL ENCLOSED = $___________ |
Make check payable to "The
Jacksonville
Historical Society"
Send this form with your check to:
The Jacksonville Historical Society
317 A. Philip Randolph Blvd.
Jacksonville, FL 32202-2217