Historic Georgetown Inc. - Membership Form

Historic Georgetown, Inc.

Membership

Membership Form

Yes, I want to become a member of Historic Georgetown, Inc.!

I am a new member. Please renew my membership in HGI

Here is my credit card information or check for the Membership type shown below.
Please just send more information about membership in Historic Georgetown, Inc.

Last Name:
First Name:
Mailing Address:
Street Address:
(if different)
City:
State or Province:
Country:
Zip or Postal Code:
Phone Number:
Email Address:

Membership type (check one):

Annual Memberships:	Lifetime Memberships: (Outside the USA add $5)
Senior/Student $20	Life Associate $1,500
Regular Member $30	Life Donor $2,500
Associate Member $50	Life Contributor $5,000
Sustaining Member $100	Life Benefactor $10,000
Supporting Member $500	Life Patron $25,000

Total amount to charge on credit card:	$
Credit Card Type: (Mastercard or VISA only)

Credit Card Number:
Expiration Date:
Security Code: (3-4 digit code on back of card)

Have you ever visited Georgetown, Colorado? (check one)

Yes
No

Please send your comments about our Web page, your visit to Georgetown, specific requests for information, or any other comments for Historic Georgetown to us by email at membership@historicgeorgetown.org.

Send form electronically or print this page and fax to Historic Georgetown, Inc. at (303) 569-2111, or print and mail with check to: P.O. Box 667, Georgetown, CO, USA 80444.

All members have one vote at the Annual Membership Meeting. Lifetime members receive framed membership certificates and other annual benefits.

Tax Information (USA) for members: In accordance with the Internal Revenue Service's guidelines which affect the portion of membership dues that can be considered a charitable contribution, members may be entitled to deduct for tax purposes the amount of their membership dues less the fair market value of the membership benefits received. To determine the amount of your membership dues which can be considered a charitable contribution, deduct $25 from the membership dues for an Annual Membership, $50 for a Lifetime Membership.