HARRISBURG-TROY HISTORICAL SOCIETY, INC.

 MEMBERSHIP APPLICATION FORM

Name(s):                                                                                                                                               
Address:                                                                                  Phone:                                                              
City:                                   State:          Zip:                             E-mail:                                                              
          lndividual          $20.00                       Contributing   $50.00                  Patron                  $500.00       
          Family                $35.00                     Sponsor        $100.00                  Benefactor       $1,000.00
                                                                                                  Membership Amount   $ _________________

Additional Contribution:   In Honor Of______________________________________
                                        In Memory Of____________________________________
                                                                                                  Additional Contribution $________________
                                                                                                  Total Amount                  $________________
For questions about your membership, contact
Sandy Schlender, Membership Chairperson                          
[email protected]
608-643-4236                                                                    
                                                                                                  Please make your check payable to: 
                                                                                                  Harrisburg-Troy Historical Society, Inc. 
                                                                                                  and mail to: 
                                                                                                  Kathy Lohr 
                                                                                                  E7905 Lohr Road
                                                                                                  Sauk City, WI 53583

Volunteer Opportunities: Please let us know if you are interested in helping with any of the projects below by placing a check mark on the line. 
Thank you!                
         Building/Grounds         
         Furnishing Donations                  
         Housekeeping             
         Open House/Greeters                  
         Cow Chip Food Stand Help                    
         Summer Picnic
____ Silent Auction Help      
        Light Up The School                                                                                


rev 7/16/15