Adams County Historical Society

Simply print this form and complete. Mail to the address listed below.

 

First Name: _________________ Last Name: _____________________________

Address: __________________________________________________________

Address: __________________________________________________________

City: ____________________________ State: _______________ Zip: _________

Telephone: _____ - _____ - ________ E-mail Address: ___________________

 

Choose from the following:

[ ] - Student . . . . . . . . $2.00 per year

[ ] - Single . . . . . . . . . $15.00 per year

[ ] - Family. . . . . . . . . $20.00 per year

[ ] - Life Single . . . . . .$125.00 (once)

[ ] - Life (over 65) . . . . $75.00 (once)

Membership runs form May 1st to April 30th of following year.

Amount enclosed: $___________ Date: ________________

Please tell us about your self and/or anything else that you would like us to know
as you become a new member:_________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

Make payable to:

Adams County Historical Society

P.O. Box 264

Friendship, WI 53934

Please do not send cash through the mail. Checks and money orders are recommended for
your safety. We would like to thank you again for your tax deductible donation.

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