Madison County Historical Society Membership
Instructions: Please print this form, complete and mail with remittance to : Madison County Historical Society, P. O. Box 696, Anderson, Indiana 46015-0696. Thank you very much.
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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