Membership Form

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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.  (orSLAHS)] should be addressed to :

Sussex-Lisbon Area Historical Society, Inc.  (or SLAHS)

Attention: Treasurer

P. O. Box 2

Sussex, WI. 53089-0002