Print clearly member name or names allowed in your selected category as listed below. Annual memberships begin on the date received with renewals due twelve months later.

Name: ________________________________________

Address: _____________________________________

City: _________________________________________

State: _________ Zip: _______________________

Telephone: _____________________________

E-Mail: _________________________________

Today’s Date: _______________________

Mark Your Membership Category

[ ] Youth to age 18 $5
[ ] Individual $25
[ ] Family $35
[ ] Contributor $55
[ ] Patron $100-499
[ ] Conservator $500-999
[ ] Benefactor $1,000 and above

Total Paid: $ __________

Clip and Mail with Payment to:
The History Museum
of Burke County, Inc.
P.O. Box 416
Morganton, North Carolina 28680-0416

Note: Your donation may be doubled if an employer has a Matching Gift Program. Donations are tax deductable under IRS code 501(c)(3).

Thank You!