~~ LUNENBURG HISTORICAL SOCIETY ~~

                          MEMBERSHIP APPLICATION

       Thank you for your interest in the Lunenburg Historical Society.
          (Printed from the Lunenburg County VAGenWeb webpage:
                     http://www.rootsweb.com/~valunenb)


NAME____________________________________________________________


MAILING ADDRESS_________________________________________________

________________________________________________________________

TELEPHONE NO.__________________E-MAIL ADDRESS___________________

PLEASE CHECK THE TYPE OF MEMBERSHIP YOU PREFER:

_____Individual - $15.00                  
_____Family   -   $25.00 
  
           Names of others in your household and their relationship to you: 
           ________________________________________________ 
           ________________________________________________ 

_____Full-time student - $10.00                  
_____ Life  - $ 250.00                  

Please make your check payable to the Lunenburg Historical Society
and mail with this application to:

Mrs.  Alice R. Roby
P. O. Box 805
Kenbridge, VA 23944

or bring this application with your check to the next meeting of the Society.

PLEASE INDICATE WITH A CHECK-MARK THE COMMITTEE
MEMBERSHIPS IN WHICH YOU WOULD BE INTERESTED:

____ Newsletter        ____ Publicity       ____ Membership
____ Budget            ____ Fund-raising    ____ Grants          ____ Activities/Projects
____ Program           ____ Tours           ____ Publications    ____ Hospitality
____ Other:___________________ 

NOTE: If yours is a family membership, please circle names 
of committees on which other members of 
your family would like to serve.

PLEASE INDICATE SPECIAL PROJECTS/ INTERESTS, 
AS WELL AS ANY  SPECIAL SKILLS/ABILITIES 
THAT YOU HAVE IN THE AREA OF HISTORY.
(Please use reverse side of this sheet if necessary.)