MEMBERSHIP
 
Copy, complete and return the appropriate form with your check or Money Order to:

DuBois Area Historical Society
PO Box 401
DuBois, Pa. 15801 

Name___________________________________________________________________________________

Address_________________________________________________________________________________

City_____________________________________________________Township_______________________  

State__________________________________________________________Zip_______________________

Phone________________________________                     New_______ Renewal_______                                      

$100 Life membership________________                 $15 Family____________________

$10 Single adult______________________                $2 Students (under 18)__________

$5 Seniors (65 and over)_________                          $5 Student (18 and over)________

______________Member/Donor (Double the membership rate)

                                                          Total amount enclosed $______________

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Business/Industry Membership Form

Business Name_____________________________________________________________________________

Contact/ Title_______________________________________________________________________________

Address___________________________________________________________________________________

             ___________________________________________________________________________________

Phone__________________________________________________________

     Choose one:

_____________$25.00 Bronze Member

_____________$50.00 Silver Member

_____________$100.00 Gold Member