Name:
_____________________________________________________________
Address:
___________________________________________________________
City/State/Zip:
_______________________________________________________
Phone
No. __________________________________________________________
Email
Address: ______________________________________________________
Amount enclosed: __________ Renewal ____
Individual
Membership $15.00
Family
Membership $25.00 (2 adults plus children under 18)
Corporate
Membership $50.00
How did you find out about the Lakeville Area Historical Society?
web ___; brochure ___; Messages page in the Life & Times ___; relative, friend or neighbor ___;
other (please explain) __________________________________________________.