Madison County Historical Society
Membership Form
Print this form, complete and mail with remittance to: Madison County Historical Society, P.O. Box 696, Anderson, Indiana 46015-0696. Thank you.
(To print this form, right click on the 3 slash marks(open menu) in the upper right hand corner of your computer screen. Go down to print, click there. Print, fill out, and send to us.
New Membership ______ Renewal _________
Name(s)__________________________________________
Address__________________________________________
City_____________________________________________
State ______ Zip ______-_____ Phone___________________
E-Mail___________________________________________
Gold ($500 or more) _____
Sponsor ($100) _______
Contributing ($50) _____
Household/Family ($40) _____
Single ($25) __________
Donation ____________
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