Sussex-Lisbon Area Historical Society, Inc.
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Membership & Annual Dues Statement
NAME:____________________________________________STUDENT/TEACHER/LIBRARIAN:_______________________________ ADDRESS:_________________________________________GRADE LEVEL/CLASS-COURSE TAUGHT:______________________ CITY/STATE/ZIP:___________________________________SCHOOL/LIBRARY:__________________________________________ TELEPHONE:_______________________________________ EMAIL:____________________________________________[Required for Newsletters/Updates]
Membership categories:
Regular Category [Voting Privilege]* Amount (per year Jan. 1 thru Dec. 31) Check (X) one
Individual $15.00 _____ Circle one > Hardcopy or Email Newsletter
Senior (65 & over) $10.00 _____ Circle one > Hardcopy or Email Newsletter
Family $25.00 _____ Circle one > Hardcopy or Email Newsletter
Contributing $30.00 _____ Circle one > Hardcopy or Email Newsletter
Business/Professional $50.00 _____ Circle one > Hardcopy or Email Newsletter
Life Time $1,000.00 _____ Circle one > Hardcopy or Email Newsletter
Junior Membership [Non-Voting Privilege]**
Grade School [Grades 1-5] $1.00 ____
Middle School [Grades 6-8] $3.00 ____
High School [Grades 10-12] $5.00 ____
Professional Associate Membership*** Teacher/Librarian Free ____
*Regular Membership Levels are open to all persons, institutions, or organizations. Regular Membership is able to vote, with one vote per member regardless of class of membership. Choice of hardcopy or email newsletter
** Junior Membership is open to school students. JR Members receive newsletter and updates by email. Free Depot Museum Admission. Non-voting meeting attendance. One free adult museum admission when accompanied by JR Member bearing membership card [card marked upon visit] .
*** Professional Associate Membership is open to all Certified/Licensed Teachers/Librarians. PA Members receive newsletter and updates by email. Free Depot Museum Admission. Non-voting meeting attendance.
Please help by offering your services in one or more of the following:
_____Service on the Board _____Fundraising _____Artifacts _____Site Maintenance _____Newsletter _____Publicity _____Membership _____Educational Programs _____Other
If “Other” checked, please indicate how you canhelp: _________________________________________________________________________
______________________________________________________________________________________________________
Membership form and check [payable to Sussex-Lisbon Area Historical Society,Inc. (or SLAHS)] should be addressed to :
Sussex-Lisbon Area Historical Society, Inc. (or SLAHS)
Attention: Treasurer
N64 W23760 Main St
Suite 240
Sussex, WI. 53089-0002