Centennial Heritage Museum Membership Application

Please complete and print the following application and return it with your payment. You may type your information into the boxes before printing.

Checks should be made out to "Centennial Heritage Museum." If you are paying by credit card, please sign the application after printing.

Centennial Heritage Museum
3101 W. Harvard St.
Santa Ana, CA 92704

You should receive your membership materials in two to three weeks.
Membership Type:
(Check one)
Individual ($25)   Family ($40)   Pioneer ($100)
Name:
Street Address:
Street Address (cont):
City, State, Zip Code:
Phone:
Email:
Payment Type:
(Check one)
Visa   Mastercard   Check
Card No.
Expiration Date:

Signature:
(If paying by credit card)

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