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Brookville Historical Society, Inc. |
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| Membership Application | |||
| Membership year is June 1 - May 31 | |||
| Categories or levels |
Annual dues except for lifetime individual membership |
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| Individual . . . . | $ | 10.00 | - one adult membership |
| Student . . . . . . | $ | 4.00 | - single membership for student to age 18 |
| Family . . . . . . | $ | 20.00 | - immediate family residing in same household |
| Sustaining . . . . | $ | 25.00 | - individuals who wish to give further support |
| Lifetime . . . . | $ | 100.00 | - one-time payment for individual membership |
| Business/Professional | $ | 25.00 | - includes two membership cards |
| Corporate . . . . | $ | 150.00 | - includes five membership cards |
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Please make check or money order payable to |
Brookville Historical Society, Inc. |
| Please print, complete form below and mail with check or M. O. | |
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| City | State | Zip Code +4 | ||||
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| * Family membership - please list names of individuals in household |
| Additional notes or comments |