MEMBERSHIP APPLICATION

Annual Individual Membership fees are:
Student ($2.50)_________ Active ($10.00)_________
Sustaining ($20.00)_________ Patron ($35.00)_________
LIFE (single payment of $200 per individual)_________
(Note: New fees are effective January 1, 2002)
Check one of the above and complete the following
if you are interested in becoming a member of the
La Porte County Historical Society, Inc.
Send application along with proper fee to:
La Porte County Historical Society, Inc.,
809 State Street, La Porte, IN 46350-3329.
| NAME_____________________________________________________
STREET ADDRESS________________________CITY_________________ STATE________________________________ZIP__________________ |
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