Application

WAYNESVILLE HISTORICAL & PRESERVATION SOCIETY, INC.

PO BOX 87
WAYNESVILLE, GA 31566

MEMBERSHIP APPLICATION

NAME_____________________________

SPOUSE NAME_________________

CITY_____________________________

STATE ___________

Email Address__________________________

ZIP_______

ADDRESS________________________________________________________

Phone#____________________

(PLEASE CHECK APPLICAPABLE BOX(ES)

[ ] FAMILY MEMBERSHIP $15.00

HISTORICAL GIFT $________

[ ] Check here if you would like a tax certificate for income tax purpouse

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