Anaconda Membership Form

American Heritage Center

Please complete the following form to submit a request for membership. If you are applying for a membership at the Academic/Historical level, please also send a letter describing your use of the collection and the results of your research (such as thesis, historical article etc.) and a brief resume or vita to the Anaconda Collection Manager. After receipt of the application a committee will review the materials and make a formal decision regarding the proposal within approximately thirty days.

Please complete all the fields below.

Membership Name: *
Contact Name:
Address: *
City: *
State: *
Zip Code: *
Telephone Number: *
Fax Number:
Email Address: *
Membership Level: *
Choose One Gold Silver Bronze Federal Government State/Local Government Academic
Designated Researchers (Membership Level Determines the Number of Researchers): *
Please Send Invoice By: *
Mail Fax (if less than 10 pages) Email Attachment