Business/Industry Membership Form

Business Name__________________________________________________________________________________________

Contact/ Title_________________________________________________________________________________________

Address________________________________________________________________________________________

             _______________________________________________________________________________________________

Phone__________________________________________________________________________________________

     Choose one:

_____________$25.00 Bronze Member

_____________$50.00 Silver Member

_____________$100.00 Gold Member

Print form and return to:

DuBois Area Historical Society, Inc.

P.O. Box 401, DuBois, PA. 15801

     Make checks payable to the DuBois Area Historical Society, Inc.

The DuBois Area Historical Society is s 501(c)3 organization.

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