MEMBERSHIP
Becoming a member of the Brillion Historical Society is easy and very rewarding!
Simply print out the membership form, complete it, and mail it to the Brillion Historical Society today!
OR you may sign up any time you stop by!
Simply print out the membership form, complete it, and mail it to the Brillion Historical Society today!
OR you may sign up any time you stop by!
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Membership Choices
[___] Junior - $1.00 (Under 18 years.)
[___] Individual - $10.00 (18 years & older)
[___] Family - $20.00 (Parents & children under 18)
[___] Contributing - $15.00 (Individual or organization wishing to support, but limited participation)
[___] Life Member - $150 (One time)
Applicant Contact Information
Name_____________________________________________
Mailing Address___________________________________
City____________________ State_____ Zip__________
Phone ____________________________________________
Email Address ____________________________________
Skill or talent that you are willing to contribute?
Please explain here:
___________________________________________________________________________
Processing Information
Please send this form, along with your personal check payable to:
Brillion Historical Society
PO Box 35
Brillion, WI 54110
Important
Note for newsletter recipients only: The year your membership dues are paid up to is next to your name on the address label.
Jane Fuhrmann, President - omafuhrmann@yahoo.com | Dean Wallace, Treasurer - dpwallace_359@msn.com
[___] Junior - $1.00 (Under 18 years.)
[___] Individual - $10.00 (18 years & older)
[___] Family - $20.00 (Parents & children under 18)
[___] Contributing - $15.00 (Individual or organization wishing to support, but limited participation)
[___] Life Member - $150 (One time)
Applicant Contact Information
Name_____________________________________________
Mailing Address___________________________________
City____________________ State_____ Zip__________
Phone ____________________________________________
Email Address ____________________________________
Skill or talent that you are willing to contribute?
Please explain here:
___________________________________________________________________________
Processing Information
Please send this form, along with your personal check payable to:
Brillion Historical Society
PO Box 35
Brillion, WI 54110
Important
Note for newsletter recipients only: The year your membership dues are paid up to is next to your name on the address label.
Jane Fuhrmann, President - omafuhrmann@yahoo.com | Dean Wallace, Treasurer - dpwallace_359@msn.com
