First Name:
 Last Name:
 Home Address:
 City: State: Zip:
 Home Phone:
 Day Time Phone: Fax:
 E-Mail:
 If you would like to be on our mailing list please check this box:
 Reserve a prominent place in history by becoming a permanent part of the Hurst  Ranch Historical Center courtyard.
 Buy a brick engraved with your name, or the names of your children and  grandchildren, your school or company, or even your pet. Hurst Ranch bricks  are  a wonderful way to acknowledge an occasion or remember a loved one.
 The cost of each personalized brick with up to three lines of engraving is just  $100. For each brick you purchase, you will receive a certificate of  acknowledgement for your or your honoree's place in history.
 Please check the following box if you want to order a brick

DONATIONS
HELP US TO:
Preserve the Past
Harvest the Present
Plant Seeds for the Future
Check here if you would like to make a donation

MEMBERSHIPS
Please Check Your Choice of Membership Status:
General: $15
Patron: $100
Silver: $1000
Friend: $25     
Sponsor: $250 
Gold: $2500     
Historian: $50   
Bronze: $500     
Platinum: $5000

  The Hurst Ranch Historical Foundation is a tax exempt, non-profit organization under
  IRS Code: 501c(3). All  gifts are tax deductible.

  For further information: about School Field Trips please email mmebutterfly.1@netzero.net
  For Community Hall rental for special occasions contact us at 626-813-0116 or info@bashfulbutler.com
  For general questions contact
us at: hurstranch@yahoo.com.

 Thank you for visiting the Hurst Ranch website, and for taking the time to fill out  our form.

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