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ASHHS Membership

American Schleswig/Holstein Heritage Society (ASHHS)

Membership Application

Dues: . . . . . . .Annually. . . . . . .5 YEARS(Includes Lapel Pin) LIFETIME (Includes Pen & Pencil Set & Plaque)

Individual _______ $18 ________ $ 85 ________________ $500

Joint __________$21 ________ $100 _______________ $750

Foreign _________ $25 _______ $120 _______________ $1000

Date:____________Amount $_____________ Check #___________ (Circle) NEW.. or.. RENEWAL

Name: ____________________________________________________ Spouse:___________________________

First Name ............Middle.................Last Name

Address: ___________________________________________

City/Town: _________________________________________

State: _________________ Zip+4: _____________________ Phone: ___________________________________

E-Mail Address_______________________________________

Make checks payable to: ASHHS; P.O. Box 506; Walcott, IA 52773-0506 U.S.A.

Membership dues received after November 1 will be credited to the following calendar year