Membership Application

____ Yes, I would like to join the Elmbrook Historical Society! Enclosed are my dues for the 2012 - 2013 calendar year.

(Please print how you would like to be listed in the

Elmbrook Historical Society's Directory.)

Name: ____________________________________________________________________

Address: __________________________________________________________________

City: _____________________________ State: ______ Zip Code: _____________________

Telephone: ___________________________ Cell Phone:____________________________

E- mail Address: ____________________________________________________________

Membership Category  - Please check one of the following:

____ Individual: $18.00 ____ Family: $25.00 ____Student (Under 18): $5.00

____ Business/Professional: $40.00 ____ Patron: $50.00

____ Life Membership: $250.00 ____ Benefactor: $1,000.00

I wish to make a donation. ________________________

The Elmbrook Historical Society is a non-profit 501 C (3) organization. All donations are tax deductible as defined by law. Financial statements are available upon request. *Some employers match not only their current employees, but also their retirees' contributions to 501c(3) non profit organizations.

Please check with your employer.

There are many ways you  can become involved in the Elmbrook Historical Society!

Please check the areas that interest you.

ADMINISTRATIVE

____ Building Maintenance ____ Data Entry ____ Gifts & Bequests ____ Grant Writing

____ Historic Preservation ____ House Maintenance ____ Landscape ____ Mailings

____ Marketing ____ Membership ____ Newsletter ____Publicity ____Rentals

____Strategic Planning ____ Visitor's Center/Gift Shop ____Website

I have special skills in:_______________________________________.

EDUCATIONAL PROGRAMS

ADULT:  ____ Lectures ____Special Events ____Tours

CHILDREN: ____ Activities____ Crafts  ____Special Events

____ I am interested in becoming a docent. Please contact me.

EXHIBITS/DISPLAYS

____ Set up exhibits at the Dousman Stagecoach Inn  Museum.

____ Create displays promoting Elmbrook Historical Society events

____ I have a special collection that I would like to display. Please contact me.

SPECIAL EVENTS

____ Civil War Days Encampment ____ Days Gone By ____ Halloween at the Inn

____ Christmas at the Inn ____ Raffle____ Silent Auction ____ Mini Fundraisers

____Organize____ Help at a special event

____ Bake ____ Prepare food for a special event

____ Sell Admission Tickets ____Sell Raffle Tickets____ Parking Attendant

____ Solicit ____ Set Up Silent Auction items ____Take Pictures

____ I will help where needed.

Please mail this form with your enclosed check payable to the Elmbrook Historical Society to:

Elmbrook Historical Society
P.O. Box 292                                                                                                          Brookfield, Wisconsin 53008 - 0292

Attention: Membership Chairman