Membership Application Form
New Member Membership Renewal
Name: Last: Middle: First:
Address1:
Address2:
City: State: Zip+4: -
Home Telephone: ( )- Work Telephone: ( )-
If you wish to be on our E-mail notice list:
E-mail:
Membership Categories(choose one): Individual $45 Senior or Full-time Student $35 Family $55 Organizational $75 Friend $100 Sustaining $250 Patron $500 Key Contributor $1000
Additional Tax-deductable Contribution:
Total Due:
Information about Volunteer Opportunities:
Information about Membership Groups:
None Auxiliary Midsommarklubben Men's Pea Soup Committee Genealogy Club
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