Membership Application

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 Friends 

Membership Application

 

Name: _______________________________________________________________

 

Address: _____________________________________________________________

 

Phone: ________________________________________

 

  • Cell: ____________________________

     

  • Fax: ____________________________

 

  I am applying for Membership in the Friends of the Johnson County Historical Commission as:

 Associate Member ($15 per year)  ___

Family Associate Members ($25 per year) ____

Sponsoring Member ($100 per year) ____

Lifetime Member ($500) ____

An Ex-Officio Member ($5 per year) ____

 

 Paid by:

Cash ____

Check # ________

 

 Received by: _____________________________                   Date: ________________