Madison County Historical Society

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 ____________