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3001 LAKE AUSTIN BLVD., SUITE 3.

116
Austin, Texas 78703
512-471-2600

www.TSHAonline.org

AT-LARGE MEMBERSHIP FORM

The Junior Historian At-Large membership rate is $7.00 a year. Membership includes a subscription to
the Texas Historian annual issue and the Roadrunner newsletter.

Student Parent/Guardian Name

Address City State Zip Code

( )
Telephone E-mail Address

_______________________________________ __________________________________________________
School School District Grade Level

( )
Teacher Teacher’s E-mail Teacher’s Phone

Method of Payment:

___ Check or Money Order enclosed (Payable to TSHA)

___ MasterCard ___ Visa ___ AMEX

Credit Card #: Exp.

CVV Code #: _______ Billing Zip Code: ________________

Cardholder Signature

Please mail this application with fees enclosed to:

The Junior Historians of Texas


Texas State Historical Association
3001 Lake Austin Blvd., Suite 3.116
Austin, Texas 78703

(Publication Sales-JH)

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