Knox Heritage, Inc. Membership Form

Name
E-Mail Address
Street
City
State		Zip
Home Phone	Work	Fax
Please contact me. I am interested in being a Knox Heritage volunteer.

Please send a gift membership to

Name
Street
City
State		Zip
Please send gift membership renewal to	Myself:  Recipient:

Membership dues (payable by check to Knox Heritage, Inc.)

Categories	Dues	Quantity	Amount
Student	$12.50
Friend	$25.00
Supporter	$40.00
Patron	$100.00
Benefactor	$500.00
1791 Heritage Society	$1000.00
	Total

Print this form and mail with check to: Knox Heritage Inc., P.O. Box 1242, Knoxville, TN 37901


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