Please print this page and mail it with your check payable to:

Sammamish Heritage Society
PMB #222, 704 228th Ave. NE
Sammamish, WA 98074


Name(s): ___________________________________________
Address: ___________________________________________
City: ______________________________________________
State: __________________ ZIP: _______________________
Phone: ____________________________________________
Email: _____________________________________________
Area of Interest: _____________________________________
__________________________________________________

Annual Dues (Please check one):
___ Individual ($15.00)
___ Student ($10.00)
___ Senior ($10.00)
___ Family ($25.00)
___ Business ($40.00)