The Millet and District Historical Society
C/O Millet and District Museum and Exhibit Room
P.O. Box 178 5120-50 Street
Millet, Alberta Canada
Daytime Phone: (_____)______________________________
Payment Enclosed by cheque or money order $_____.___
Please send me a tax-deductible receipt for my donation of $ __________ over and above the membership fee.
Please make cheques payable to the Millet and District Historical Society.
Please print this form and mail it to the above address.