Madison County Historical Society

Annual Membership

Print this form, complete and mail with remittance to the address below. Please print. Thank you.

New Membership ______ Renewal _________

Name(s)__________________________________________

Address__________________________________________

City_____________________________________________

State ______ Zip __________ Phone____________________

E-Mail___________________________________________

Sponsor ($100) _______

Contributing ($50) _____

Single ($20) __________

Family ($30)__________

Student ($5)__________

Donation ____________

Please mail to: Madison County Historical Society, P. O. Box 696, Anderson, IN 46015-0696.