NORTH MANCHESTER HISTORICAL SOCIETY
MEMBERSHIP FORM FOR YEAR 2011

NAME _________________________________________

ADDRESS _______________________________________

_______________________________________________

E-MAIL ________________________________________

PHONE ________________________________________

Kind of Membership (1 year):

□    Individual Membership…………………………………………..              $ 30.00

□    Couples Membership………………………………………………              $ 50.00

□    Family Membership………………………………………………..               $ 60.00

□    Grandparents Membership……………………………………..             $ 60.00

□    Sustaining Membership………………………………………....              $ 75.00

□    Supporting Membership……………………………………….                $100.00

□    1 year newsletter only………………………………………….                  $ 20.00

□    GIFT TO SUPPORT:

                                Operating Expenses              ______________

                                Thomas Marshall House      ______________

                                Museum                                  ______________

                                Endowment                            ______________

Amount enclosed ____________________
Dues are valid from Jan 1 to Dec 31. Membership includes a newsletter
subscription, free admission to the N.M. Center for History, 10% gift
shop discounts and other benefits. Thank you for your support!

Make checks payable to North Manchester Historical Society, Inc.

P.O. Box 361, North Manchester, Indiana 46962