Membership Application and Donation Card

Please print this form out and mail it along with a donation to:

The Copper Range Historical Society

P.O. Box 148

South Range, MI 49963

Name __________________________________________

Address __________________________________________

__________________________________________

__________________________________________

	Individual Membership	$10.00
	Family Membership	$15.00
	Supporting Membership	$50.00
	Life Membership	$100.00
	Corporate Sponsor	$1,000.00
	Corporate Patron	$5,000.00
	New Member
	Renewal
	Donation Amount	$

Please make checks payable to: The Copper Range Historical Society

Thank you.