Your Name ______________________________________________________________________

Your Address ____________________________________________________________________

City ___________________________________________________________________________

State & Zip Code_________________________________________________________________

E-mail address __________________________________________________________________

Daytime Phone (with area code)	Evening Phone (with area code)
_____________________________________	_____________________________________

Membership Catagories	Life Member -- $250
	Business -- $50
	Patron -- $50
	Household -- $25
I am donating	$_____________________	in addition to my membership fee.
I have enclosed $__________	Please make checks payable to:	HBHS. Thank you!

Your Participation Is Welcomed! --- Please mark your interests

Museum display		Photo Collecting		Socials
Docent		Fiesta Booth		Newsletters
Cataloging		Publicity		Tours

Please print this page and mail to :
Hermosa Beach Historical Society -- 710 Pier Avenue, Hermosa Beach, CA 90254

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