Membership Application Form

Ryker-Riker Historical Society  MEMBERSHIP   APPLICATION  FORM

By becoming a member of the Ryker-Riker Historical Society you will:

TO USE THIS APPLICATION FORM, please (1) fill out the form below (type into the open boxes), (2) print it (File --> Print on your browser), and then (3) mail it -- along with your check for the correct amount, made payable to The Ryker-Riker Historical Society, Inc. -- to:

                                The Ryker-Riker Historical Society, Inc.
                                Conrad L. Burton, Acting Treasurer
                                43779 Valley Rd
                                Decatur MI  49045-8905
                                 

I would like to become a member of    -or-   renew my membership in The Ryker-Riker Historical Society, Inc.  I understand that annual dues are $10 for Regular members, $2 for Junior members (under age 18), $15 for Associate members (libraries), and $25 or more for Sustaining members (those who wish to support the Society at a higher level).  Just type your desired membership status directly into the form below.  Please consider giving gift memberships to relatives or friends!

     QTY         DESCRIPTION                                     PERSON'S NAME
   Regular membership for     
   Regular membership for     
   Regular membership for     
   Junior membership for        
   Junior membership for        
   Junior membership for        
   Associate membership for  
   Sustaining membership for 

                     BILLING
Check for is enclosed.


DELIVERY ADDRESSES (for each name listed above)
             Name       
Street address/Apt. No.    
Address (cont.)     
            City           
  State/Province   
Zip/Postal code    
            Country    
Home 'phone (incl. area code)    
        E-mail address     

DELIVERY ADDRESSES (for each name listed above)
             Name       
Street address/Apt. No.    
Address (cont.)     
            City           
  State/Province   
Zip/Postal code    
            Country    
Home 'phone (incl. area code)    
        E-mail address     

 

DELIVERY ADDRESSES (for each name listed above)
             Name       
Street address/Apt. No.    
Address (cont.)     
            City           
  State/Province   
Zip/Postal code    
            Country    
Home 'phone (incl. area code)    
        E-mail address     

 

Note: If additional Delivery Address forms are needed, just reset the form after printing it, enter the new addresses, and print again.

 

Last revised: October 29, 2003