Printable Membership Form
YOU CANNOT FILL THIS OUT ONLINE ... IT MUST BE PRINTED!!!
Make check out to -- Clive Historical Society for the amount of the
membership. Check off the proper type of membership.
Send to:
Clive Historical Society
P O Box 22043
Clive, IA 50325
Name/Business ____________________________________
Address
__________________________________________
City ___________________, St _______________ Zip _________
Business Phone ______________ Home Phone _______________
e-mail address ___________________________________
Membership - NEW or RENEWAL (circle one)
| Check one |
Active | Yearly fee | Life Time Fee |
| _____ | Individual | $10.00 | $100.00 |
| _____ | Family* | $15.00 | $150.00 |
| _____ | Business/Professional | $25.00 | $250.00 |
_____ I am interested in becoming a member of the Clive Historical Society. Please find my check enclosed.
_____ I would like to make a contribution for the restoration of the Clive Depot and General Store. Please find my check enclosed.
_____ I would like to know more about the Clive Historical Society and would like to help.
For more information please contact Linda at: mailto:mrslrs@aol.com
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