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Membership Form:
To join, print this page, fill out the information and
send it by fax or mail to:
Fort Lauderdale Historical Society
219 SW Second Avenue
Fort Lauderdale, FL 33301
FAX: 954-523-6228
Yes! I would like to join!
| MEMBERSHIP CATEGORIES
(PLEASE SELECT ONE) |
|
| Student/Teacher |
$35 |
| Young Professional |
$45 |
| Individual |
$50 |
| Family |
$75 |
| Sustainer |
$100 |
| Benefactor |
$250 |
| Steward |
$500 |
| Corporate |
$1000 |
The Villagers of Old Fort Lauderdale |
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Kings Creek Villager $1,000
Pioneer Villager $2,500 Heritage Villager $5,000
| CONTACT INFORMATION
(PLEASE COMPLETE) |
|
| Name |
______________________________________ |
| Address 1 |
______________________________________ |
| Address 2 |
______________________________________ |
| City |
______________________________________ |
| State/ Zip |
______________________________________ |
| Telephone |
______________________________________ |
| Email |
______________________________________ |
|
| PAYMENT METHOD
(PLEASE SELECT ONE) |
|
| __ Check enclosed
__ American Express __ Visa __ Mastercard |
|
| CREDIT CARD INFORMATION
(PLEASE COMPLETE) |
|
| Credit Card Number |
______________________________ |
| Expiration Date |
______________________________ |
| Name as it appears on Card |
______________________________ |
| Signature of Cardholder |
______________________________ |
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