La Porte County Historical Society, Inc.

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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