The Historical Museum at St. Gertrude ------------------------------------Membership Application-------------------------------------- Payment Method (check one): Check enclosed*___ Master Card___ Visa___ Card Number _______________________________Expiration Date ________________ Signature (required)_________________________________Phone (____) ___________ Name:_________________________________________________________________ Address:________________________________________________________________ City, State, Zip___________________________________________________________ Phone: (_______) ___________ Email:_________________________________________ Circle preferred Membership category:
	Pioneer - $15.00 Prospector - $25.00 Homesteader - $35.00	Settler - $75.00+ Old Timer - $1,000 Camas Prairie Society - $1,000+
-----------------------------------Membership Application---------------------------------------- *Make checks payable to:The Historical Museum at St. Gertrude

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