Membership Application

____ Yes, I would like to join the Elmbrook Historical Society! Enclosed are my annual dues extending for 12 months from date of payment.

(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 choose one of the following:

.Individual $18.00 ____ Family $25.00______ Bronze $50.00____ Silver $100.00_____

Gold $250.00______ Platinum $500.00 _____   Lifetime $750.00_____

Business $75.00 ______

I wish to make a additional donation of $________________________

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 volunteer opportunities available, please let us know if you would like to help as a docent, for a single event, by baking for events and much more.  Just email us your interests:  elmbrookhistoricalsociety@gmail.com

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

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