____ New Membership   ____ Renewal ____ Gift

____ Individual: $40/year, or $70 two years (Save $10) ____ Household: (2 adults, kids under 18) $55/year or $100 for two years (Save $10) ____ Contributing: $150 per year ____ Supporting: $250 per year ____ Sustaining: $500 per year ____ Founder: $1000 per year

Contributions are tax deductible in accordance with IRS regulations.

Your Information:

Name _______________________________________________________

Address ______________________________________________________

City _________________________________ State _________________ Country _________

Postal Code (Zip) ______________________

Telephone (day) __________________________ (evening) ____________________________

Email _______________________________________________

Please send a gift membership to:

Name(s) _______________________________________________________

Address ______________________________________________________

City _________________________________ State _________________ Country _________

Postal Code (Zip) ______________________

Telephone (day) _________________________ (evening) ___________________________

Email _______________________________________________

Join now. You can include payment by check or money order, or use the credit card form below.
Please print out the mail-in enrollment form, fill it in, and send it via regular mail.

Form of payment:

____ Check payable to the Nebraska State Historical Society

____ Mastercard     ____Visa    ____Discover

Expiration Date ____________________________

Card # ___________________________________

Signature _________________________________

Want to know more about the Nebraska State Historical Society?
Call 402-471-3272 Call toll-free 1-800-833-6747 FAX 402-471-3100	Nebraska State Historical Society Attn: Membership Coordinator 1500 R Street PO Box 82554 Lincoln, NE 68501-2554

Trouble printing? Download a Membership Application Form in PDF format.