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.
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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
