

Wabasha County Historical Society
Membership Application
Name - ____________________________________________________________________________________
Address - _______________________________________________________________________________________________________________________________
Street City State Zip
Telephone - _________________________________________________________ Email - __________________________________________________________
Please Check Your Membership Level
__________ - Individual - $25.00 __________ - Family - $40.00 __________ - Patron - $100.00
__________ - Small Business (50 Employees or Less) - $150.00 __________ - Corporate (51 Employees or More) - $250.00
Please note: The dues schedule is only a suggestion. We are grateful for all contributions.
All Contributions are Tax Deductible.
Please make your check payable to: Wabasha County Historical Society
Mail to: Wabasha County Historical Society PO Box 255 Lake City, MN 55041
Please Check Your Area(s) of Interest
__________ - Officer/Board Member __________ - Artifact Inventory ___________ - Fundraising
__________ - Membership Drives __________ - Building Grounds ___________ - Exhibit Design/Planning
__________ - Genealogy __________ - Public Relations __________ - Guide/Docent
__________ - Grant Writing __________ - Special programing __________ - Other ___________________________
