Annual
Membership Contribution
Amite County Historical and Genealogical Society
PO Box 2
Liberty, MS 39645
Check or circle choice of membership type |
|
( ) $15.00–Individual |
( ) $50.00 – Sponsor or Memorial |
( ) $25.00–Family |
( ) $200.00 – Lifetime |
( ) $10.00–Student (under 18) |
( ) $10.00 – Senior (over 65) |
All contributions are tax deductible.
Please make checks or money orders payable to
Amite County Historical and Genealogical
Society
PLEASE PRINT:
Name:
____________________________________________________________________
Address:
__________________________________________________________________
City:
______________________________ State: ______ Zip: __________ Zip+4: ________
Telephone(s):
______________________________________________________________
E-mail address(es): _________________________________________________________
Thank
you for joining the Amite County Historical and Genealogical Society. Your
contribution
helps us continue to collect and preserve historic treasures from
Amite
County’s past, as well as to promote family history. Membership also
provides
an opportunity to attend programs and participate in special events.
I am interested in helping
with:
( ) Archives ( )
Membership ( ) Programs ( ) Newsletter
(
) Other (specify): __________________________________________________________