Sussex-Lisbon Area Historical Society, Inc.
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Membership & Annual Dues Statement
Name: _________________________________________________
Address: _______________________________________________
______________________________________________________
City/State/Zip: ___________________________________________
Phone: _________________________________________________
E-mail (optional): _________________________________________
Membership categories:
| Category | Amount (per year Jan. 1 thru Dec. 31) | Check (X) one |
| Individual | $15.00 | _____ |
| Senior (65 & over) | $10.00 | _____ |
| Family | $25.00 | _____ |
| Contributing | $30.00 | _____ |
| Business/Professional | $50.00 | _____ |
| Life Time | $1,000.00 | _____ |
**Membership is open to all persons, institutions, or organizations. Membership is able to vote, with one vote per member regardless of class of membership**
Please help by offering your services in one or more of the following:
| _____Service on the Board | _____Fundraising | _____Artifacts |
| _____Site Maintenance | _____Newsletter | _____Publicity |
| _____Membership | _____Educational Programs | _____Other |
If "Other" checked, please indicate how you can help: _________________________________________________________________________
______________________________________________________________________________________________________
Membership form and check [payable to Sussex-Lisbon Area Historical Society, Inc. (or SLAHS)] should be addressed to :
Sussex-Lisbon Area Historical Society, Inc. (or SLAHS)
Attention: Treasurer
P. O. Box 32
Sussex, WI. 53089-0032