AHC Anaconda Membership Request Form


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American Heritage Center
University of Wyoming
Mailing Address:
Dept. 3924
1000 E. University Avenue
Laramie, WY 82071
307.766.4114
ahc@uwyo.edu

Anaconda Membership Request Form

Please complete the following form to submit a request for membership. For additional application instructions for the Academic/Historical level, please review the Anaconda Frequently Asked Questions PDF (23 k)

You may also print out the form and send it to:

Ginny Kilander
American Heritage Center
University of Wyoming
Dept. 3924
1000 E. University Ave.
Laramie, WY 82071
Phone: 307.766.2553
Fax: 307.766.5511
E-mail: papyrus@uwyo.edu

1. Date:

2. Membership Name:

3. Address:

4. Contact Name:

5. Telephone

6. Fax:

7: E-mail:

8. Membership Level:

9. Designated Researchers (Membership level determines the number of researchers):

10. Please send invoice by:		Mail Fax (only if ten pages or less) E-mail attachment