Fiscal Year Begins July 1st. Please print this form and mail it (with your check) to the Charlevoix Historical Society, P.O. Box 525, Charlevoix, MI 49720.
New Member Application
Membership Renewal
Name:
Summer Address:
City, State, Zip:
Phone:
Email:
From:
To:
Please fill in next section if winter address is different from summer address.
Winter Address:
City, State, Zip:
Phone:
Email:
From:
To:
Life Member Choices:
Annual Patron Membership:
Life Member - Individual ($250.00)
Diamond ($2000 or more)
Life Member - Couple ($400.00)
Platinum ($1000-$1999)
Annual Membership Choices:
Gold ($750-$999)
Individual ($15.00)
Silver ($500-$749)
Family ($25.00)
Bronze ($350-$499)
Ralph Hamilton Circle ($100 annually)
Credit Card #: - - - Exp. Date:
Thank you so much for supporting the Charlevoix Historical Society!
