South Lake County Agricultural Historical Society

Membership Application

Name_______________________________________________Spouse_____________________

 Street Address___________________________________________________________________

 City____________________________________State______________Zip___________________

 Phone Number__________________________________________________________________

Yearly Dues $10.00_________________________Lifetime $150 minus age__________________

Please note: Yearly Dues are due by April 1

Please make checks payable to South Lake County Agricultural Historical Society.

Return this form to:

South Lake County Agricultural Historical Society

PO BOX 847

Crown Point, IN  46308