Login  |  Register  |  Search

Forms

NORTH LEE COUNTY HISTORICAL SOCIETY

MEMBERSHIP APPLICATION/RENEWAL

 

            Annual membership in the North Lee County Historical Society assists in funding operational expenses for the Depot Complex Historic Center, Brush College, Old Lee County Jail and with future operations and projects. The NLCHS is dedicated to serving the communities in North Lee County, Iowa. Your support of the society’s important work is greatly appreciated and will assist in building appreciation for our past and shared heritage.

            Membership in the NLCHS entitles you a free admission to the above supported facilities. Family, Individual and Business memberships are for a period of one year beginning on May 1 of each year. Free will donations can be applied to any area of museum operations or general fund if not specified.

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

 

                                                                                                Date:_____________________

 

Is this a (Circle One)    Renewal   or   New   application:

 

Name:________________________________ Phone:______________ Cell:________________

 

Address:_______________________________ Email:__________________________________

 

City, State, Zip:_________________________________________________________________

 

Individual _____ at $15.00, Family ____ at $30.00 (list family members), Business at $60.00 (list 2 reps for contact and voting purposes to issue membership cards to)

 

Total Enclosed:____________ List Family/Business Members:___________________________

 

______________________________________________________________________________

Freewill Donation: $__________________ Do you have a specific funding area request: Yes  No

 

Area if answered Yes:____________________________________________________________

 

Do you wish to volunteer in any area (i.e Tour guides, Labor, Gift Shop, Committees, etc.:____________

 

_____________________________________________________________________________________

 

Mail completed membership application and any donation amount to:

 

North Lee County Historical Society

P.O. Box 285

Fort Madison, Iowa 52627

 

YOUR MEMBERSHIP CARD WILL FOLLOW

 

 

Rev: 3/30/2011 

This non-profits service by Grassroots.org and Doodlekit™ Free Website Builder