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Natural History Museum Membership Form

Print out and mail to:

HSU Natural History Museum
1315 G Street
Arcata, CA 95521

Membership Type (Circle One)

Type	Student /Senior	Individual	Associate	Friend	Patron	Supporter	Benefactor	Nautilus Club
Price	$20	$30	$45	$75	$100	$250	$500	$750+

 

Additional tax-deductible donation _______________________

Name _______________________________________________

Address _____________________________________________

City ______________________ State ________ Zip _________

Phone (day) ________________ (eve) ____________________

For Family Membership only: print full names and birthdates of children under 18:

Name ______________________ M/Y of Birth ____________

Name ______________________ M/Y of Birth ____________

Name ______________________ M/Y of Birth ____________

Thank You!