The Van Buren County Historical Society invites your support of our activities in any of the following ways:
| ACTIVE MEMBERSHIP - attend monthly meetings | $10.00 |
| INACTIVE MEMBERSHIP - I want to help | $10.00 |
| SUPPORTIVE CONTRIBUTION - ("A little or a Lot") | $_______ |
|
Total Enclosed: |
$_______ |
| Name: __________________________________________ |
| Street or Box: ____________________________________ |
| City: ___________________________________________ |
| State: ____________________ Zip: __________________ |
| Phone Number: ___________________________________ |
Print Form and Mail to:
Van Buren Co. Historical Society
PO Box 236
Keosauqua, IA 52565