Annual Contribution Level- Please check one.

Individual Memberships:

___ Historian ($50)   ___ Biographer ($100)

____ Collector ($250)    ____ Scholar ($500)   

____ The Fellows ($1,250)     ____ Statesman ($5,000)     ____Impressario ($10,000)

Business Partner Membership:

___ Susanna Dickinson Circle ($2,500)   ___ Stephen F. Austin Circle ($5,000)  

___ Sam Houston Circle ($10,000)

Mr./Dr./Mrs./Ms.:_________________________________ Spouse:____________________

For Business Partners--Name of Business:_____________________________________

For Business Partners -- # of Employees: ____ (25 or Less) ___ (25 - 100) ____(100+)

Address:____________________________________________________________________

City:_______________________________ State:_________________ Zip:______________

Telephone #: Hm.___________________________ Cell_________________________

                     Wk.___________________________ FAX_________________________

Email:__________________________________________________

Payment: ____Check Enclosed    ____VISA/MASTERCARD    ____AMERICAN EXPRESS

Card #:____________________________________________ Exp. Date: _____/_____

Please mail to: DALLAS HISTORICAL SOCIETY, P.O. BOX 150038, DALLAS, TEXAS 75315-0038