Special Note: You do not have to be a resident of Surprise to join - we welcome everyone to participate!

MEMBERSHIP FORM

SURPRISE HISTORICAL SOCIETY MEMBERSHIP APPLICATION

Mission Statement for the Surprise Historical Society:

"To inspire the people of Surprise to be interested in the roots of the community in which they live."

*THE SURPRISE HISTORICAL SOCIETY ORGANIZATIONAL MEMBERSHIP FEES:

$15.00 PER PERSON (PER YEAR): ______ PATRON: $__________

Please fill out a separate application for each member/patron

PLEASE PRINT INFORMATION BELOW:

DATE: _________________ NEW: _____ RENEWAL: _____

NAME: _____________________________________________________________

ADDRESS: _____________________________________________________________

_____________________________________________________________

CITY: _________________ STATE: ___________ ZIP CODE: _______________

PHONE: _______________ CELL: ____________

E-MAIL ADDRESS: _________________________________________________

$ AMOUNT ENCLOSED: __________________

PLEASE MAKE CHECKS PAYABLE TO: THE SURPRISE HISTORICAL SOCIETY, LLC

REGISTRATION: Please mail registration form and check to:

President, Nancy Alcock

20004 N. Window Rock Drive

Surprise, Arizona 85374

Questions, please call: 623-266-0988

"*The Surprise Historical Society LLC is a non-profit company, registered in the State of Arizona".

We thank you for supporting the History of Surprise