Sussex-Lisbon Area Historical Society, Inc.

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Membership & Annual Dues Statement

 
NAME:____________________________________________ STUDENT/TEACHER/LIBRARIAN:_______________________________
   
ADDRESS:_________________________________________ GRADE LEVEL/CLASS-COURSE TAUGHT:______________________
   
CITY/STATE/ZIP:___________________________________ SCHOOL/LIBRARY:__________________________________________
   
TELEPHONE:_______________________________________  
   
EMAIL:____________________________________________[Required for Newsletters/Updates]  
   

Membership categories:

 

Regular Category [Voting Privilege]* Amount (per year Jan. 1 thru Dec. 31) Check (X) one
Individual $15.00 _____    Circle one > Hardcopy or Email Newsletter
Senior (65 & over) $10.00 _____    Circle one > Hardcopy or Email Newsletter
Family $25.00 _____    Circle one > Hardcopy or Email Newsletter
Contributing $30.00 _____    Circle one > Hardcopy or Email Newsletter
Business/Professional $50.00 _____    Circle one > Hardcopy or Email Newsletter
Life Time $1,000.00 _____    Circle one > Hardcopy or Email Newsletter
Junior Membership [Non-Voting Privilege]**    
Grade School [Grades 1-5] $1.00 ____
Middle School [Grades 6-8] $3.00 ____
High School [Grades 10-12] $5.00 ____
Professional Associate Membership***    
Teacher/Librarian Free ____

*Regular Membership Levels are open to all persons, institutions, or organizations. Regular Membership is able to vote, with one vote per member regardless of class of membership. Choice of hardcopy or email newsletter

** Junior Membership is open to school students. JR Members receive newsletter and updates by email. Free Depot Museum Admission. Non-voting meeting attendance. One free adult museum admission when accompanied by JR Member bearing membership card [card marked upon visit] .

*** Professional Associate Membership is open to all Certified/Licensed Teachers/Librarians. PA Members receive newsletter and updates by email. Free Depot Museum Admission. Non-voting meeting attendance.

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