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2. Date*
   Date
4. Name*
   First and Last Name
5. Email Address*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
15. I would prefer to receive my newsletter and notifications via...*
    -- Select One --EmailIn the mail
17. This is a... *
    -- Select One --New MembershipRenewed Membership
19. Membership Level*

    Membership fees cannot be processed online at this time. Please mail membership fee to: Homesteaders Museum, PO Box 250, Torrington, WY 82240 or bring fee to the Museum. Checks can be made out to The Homesteaders Museum. Membership will be active once fees are received.

    1. $10 Individual
    2. $20 Family
    3. $25 Business
21. I would like more information regarding...*

    Please check all that apply.

    1. Volunteering at the Museum
    2. Donating to the Museum
    3. How to conduct research at the Museum
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23. 1. Receive an email copy of this form.
24. Email address

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25. Submit

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