Historical Society Membership Application

Anyone interested in King and Queen County and its history is invited to join.

Please note: This is not an interactive form. To use it, you must print it out and then fill in your information with a pen or typewriter. Then mail with your check to

King and Queen Historical Society
P.O. Box 129
King and Queen Court House, VA 23085-0129

Name:
Address:
City, State, ZIP:
Phone:
Email:
Check one category below:
	Annual dues, individual	$15.00
	Annual dues, couple	$20.00
	Annual dues, student	$4.00
	Life membership, individual	$300.00
	Life membership, couple	$400.00