Membership Application and Renewal

Name:_______________________________________

Address:_____________________________________

City:_________________State:___________________

Zip:__________PH#:___________________________

email address:_________________________________
$30.00   Individual Annual
$40.00   Family Annual
$50.00   Business Annual
$500.00   Life Sponsor
$1,000.00   Patron
$5000.00   Benefactor
Membership Information

 To join or donate, please print out this page

Send to the following address
Galloping Goose Historical Society of Dolores, Inc.
PO Box 297
Dolores, CO 81323

For additional Information
970-882-7082    Fax: 970-882-3243
Email:  gghs5@centurytel.net