2010 Membership Application / Dues Renewal

2010 MEMBERSHIP APPLICATION / DUES RENEWAL

THE U.S. DISTRICT COURT OF OREGON

HISTORICAL SOCIETY

Enclosed is my application and/or annual membership dues to join the United States District Court Historical Society (please check level of membership desired):

General ($50)              Sustaining ($75)                     Sponsor ($150)
Lifetime ($1,000)        Judicial Law Clerk ($15)      Student $($15)
Admitted to U.S. District Court for more than 1 year and less than 4 years ($25)
Newly admitted to U.S. District Court ($15)

If this donation is made in honor of a particular person, organization or event, please list:

In Honor Of _______________________________________________________

Please mail your check and this form to:

                        The United States District Court of Oregon Historical Society
                        c/o Michelle Barton, Treasurer
                        Miller Nash, LLP
                        111 SW 5th Ave
                        Suite 3400
                        Portland, Oregon 97204

NAME:

(Last Name) (First Name) (Middle Initial) (Mr./Mrs./Ms.)

E-MAIL ADDRESS:

FIRM:

ADDRESS:

CITY: STATE: ZIP:

WORK PHONE: HOME PHONE:

FACSIMILE NO.:

The historical society is a 501(c)(3) not-for-profit organization. Some or all of your membership dues may be tax deductible, please consult your tax advisor for more information and keep a copy of this form for your tax records. The historical society is also a member of the Oregon Cultural Trust (www.culturaltrust.org). Members may be eligible to receive a state tax deduction for their donations through the Oregon Cultural Trust, see www.culturaltrust.org for more details.