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Membership: Become a Member Form

* Required fields     Individual Membership *   Individual/Senior $35 Partner $250 Dual/Family $50 Advocate $500 Associate $100 Patron $1,000    Corporate Membership *   Concierge $500 Corporate Associate $1,000 Corporate Partner $2,500 Corporate Advocate $5,000 Corporate Patron $10,000      Member Information Date: October 10, 2008 * Name (1):   * Name (2):   * Street Address:   * City:   * State/Province:   * Zipcode:   * Home Phone:   * Work Phone:   * Email Address:      Method of Payment *   Master Card Visa   NOTE: If paying by credit card, we will contact you by phone to obtain your card number. Personal Check   Make checks payable to: History San José 1650 Senter Road San Jose, CA 95112-2599    Gift Membership Is this a gift membership? Gift From: Gift Card Message:    Matching Gift Program If you are employed by a company with a matching gift program, you can double your donation to us. Contact membership services for more information at (408)918-1053 Employer:    Request more information on Volunteer Opportunities Donations/Sponsorships

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