MEMBERSHIP FORM
Shipshewana Area Historical Society
PO Box 929
Shipshewana, IN 46565
Name:_________________________________________________________________
Business Contact Person: ______________________________________________
Address:_______________________________________________________________
City: _____________________________________ State: __________ Zip:________
Phone: __________________________________ Cell: ________________________
Email address: ________________________________________________________
Please check one (1) that applies
________ Annual Membership $ 10.00
________ Couple Annual Membership $ 20.00
________ Business or Corporation Annual Membership $ 100.00
________ Lifetime Membership $ 100.00
________ Bronze Annual Membership* $ 200.00
*Membership includes recognition in the SAHS Newsletter*
________ Silver Annual Membership* $ 500.00
*Membership includes recognition in the SAHS Newsletter & two (2) Annual Dinner Tickets*
________ Gold Annual Membership* $1000.00
*Membership includes recognition in the SAHS Newsletter & four (4) Annual Dinner Tickets*
*All Memberships receive the SAHS Monthly Newsletter*