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DCHS Membership Application
Membership Level                   Annual Dues
 Individual Member                   $10.00
 Family Member                   $20.00
 Organization Member                   $30.00
 Sustaining Member                   $50.00
 Business Member                   $75.00
Name: _____________________________________
Address: ___________________________________
City: _______________________________________
State/Prov: ________ Zip/Post Code: _________
Country: ___________________________________
Phone: ____________________________________
Email: _____________________________________
Method of Payment:   Check     Money Order

Tax Deductible Donations also accepted. Enclose with your application or mail separately to DCHS at the address above. Thank you.

To contact us:
Phone: 812-537-4075
Address: 508 West High Street
Lawrenceburg, IN 47025
Copyright 2008-2011 Dearborn County Historical Society