Print the form below, fill out and mail to the address below with your check or money order.
 
 
Date____________________				Print
 
YES!! I would like to become a member supporter of the 
Bismarck Mandan Historical and Genealogical Society, Inc. 
 
Enclosed is my check for membership. Annual dues are: 
______ $15.00 Single
______ $17.00 Family/household 
______ $20.00 Supporting member 
 
NAME_____________________________________________________________________ 
 
ADDRESS__________________________________________________________________ 
 
CITY_____________________________________________________________________
 
STATE/PROVINCE________________________________________________ZIP________
 
E-MAIL ADDRESS___________________________________________________________
 
SURNAMES BEING RESEARCHED________________________________________________ 
 
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COUNTRIES/STATES BEING RESEARCHED _______________________________________
 
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COMMITTEE/OFFICER INTERESTS______________________________________________