Vernon County Historical Society
Membership for Jan. 1st - Dec. 31
New___  Renewal___

Name____________________________
Address__________________________
               __________________________
Telephone________________________
Check kind of Membership:

Annual Memberships
___ Individual      $15.00
___ Family           $25.00
___ Supporting   $50.00
___ Business       $50.00

__ Dawson Heritage Club $100.00 /yr.
__Friends of the Sherry-Butt House
___$50.00 ___$75.00 ___$100.00
__Friends of the Foreaker Country School


Life memberships
___Bronze                               $ 250.00
___Silver                                  $ 500.00
___Gold                                   $ 1,000.00
___Platinum                             $ 5,000.00
___Diamond                            $ 10,000.00
___Benefactor over                 $ 10,000.00

Make checks payable to:
Vernon County Historical Society
Box 444 Viroqua, WI 54665

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Have you remembered the Vernon
County Historical Society with your
memorials and in your will?
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