American Schleswig/Holstein Heritage Society (ASHHS)
Membership Application
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