Application for Membership

To join the Congress, or renew your membership, print and fill in this form. Please print your information, and mail with check or money-order (payable to: Congress of History).

• Mail to: Membership Chair, Helen Halmay, PO Box 1346, Lemon Grove, CA 91946-1346
• A benefit of membership is receiving Adelante during the year.
• If you have questions about your membership, call Helen Halmay at 619-469-7283.

2004 Membership (Check one, below)
__$12 Individual  __$15 Family  __$12 Organization  __$50 Donor  __$150 Life

Person/s Name (NOT organization)_____________________________________________

Personal Address (NOT organization)__________________________________________

City, State, ZIP_____________________________________________________________

Home Phone___________________________  Work Phone____________________________

Personal E-mail Address (NOT organization)___________________________________

NOTE: Please mail Adelante to MY address ABOVE:  __Yes (__No use address below, instead)

Organization (if any)________________________________________________________

Address______________________________________________________________________

City, State, ZIP_____________________________________________________________

Organization Phone___________________________________________________________

Organization's E-mail Address________________________________________________

Organization's Web Site (if any)_____________________________________________

I am the official representative from my group to the Congress: __ Yes __ No (Please check one)

If your group has a Museum, what is it's name & location address (if different from the above); what are its days and hours of operation, and what is the entrance cost? Thanks!