Blair Historic Preservation Alliance
2009  Membership Form

Name:   _____________________________________________________

Address: ____________________________________________________

City: ____________________ State: __________ Zip: ________________

Telephone: __________________________________________________

E-mail address: _______________________________________________

:

Renewal

New

	Annual Memberships				Annual Patrons
		$ 10	Standard			$ 50	Sponsor
		$ 25	Friend			$100 +	Patron

Please mail this form, and your check made payable to the:

   Blair Historic Preservation Alliance

Mail to:

   BHPA - Membership
   P.O. Box 94
   Blair, Nebraska  68008