NORTH MANCHESTER 
HISTORICAL SOCIETY 
MEMBERSHIP FORM FOR THE CURRENT YEAR
Join Now/Renew Now...
NAME _________________________________________
ADDRESS _______________________________________
_______________________________________________
CITY ___________________________________________
STATE______________________ ZIP __________________
E-MAIL ________________________________________
PHONE ________________________________________
Yes, I would like to become a member of the
North Manchester Historical Society at the following level:
Kind of Membership (1 year):
□   
Individual 
Membership…………………………………………..             
$ 30.00
□   
Couples 
Membership………………………………………………             
$ 50.00
□   
Family 
Membership………………………………………………..              
$ 60.00
□   
Grandparents 
Membership……………………………………..            
$ 60.00
□   
Sustaining 
Membership………………………………………....             
$ 75.00
□   
Supporting 
Membership……………………………………….               
$100.00
□   
1 year newsletter 
only………………………………………….                 
$ 20.00
□   
GIFT TO SUPPORT:
donation of $ ______________________ toward:
________ General, Unrestricted
________ Center for History
________ Thomas Marshall House
________ Endowment
________ Other (Please specify: ______________________________________________
Dues are valid from Jan 1 to Dec 31. 
Membership includes a newsletter 
subscription, free admission to the N.M. Center for History, 10% gift
shop discounts and other benefits. Thank you for your support!
Make checks payable to North Manchester 
Historical Society, Inc.
P.O. Box 361, North 
Manchester, Indiana 46962