JOIN THE

• You may also print out this page, fill out the information, 

and mail it with your check, moneyorder or credit card info to: 

  Pacifica Historical Society, Box 752, Pacifica CA 94044

YOUR INFO

• Name:
• Address:
• Phone #:
• Email:

CREDIT CARD INFO

• Type (circle one): Visa / MasterCard / Amex
• Card #: 
• Expiration:
• Code (on back):

Membership level (circle one):

• $500 (PHS Gold)
• $250 (PHS Silver)
• $100  (PHS Patron)
• $25 (Family, Couple)
• $20 (Individual, Senior Couple)
• $15 (Senior or Student Individual)