2. Membership*

   1. Renewal
   2. New Membership
4. Name and/or Spouse's Name (If Applicable)*
6. Address*
8. City*
9. State*
10. Zip*
12. Number of Children Under Age 18*
13. Membership Type*

    1. Single ($20)
    2. Family ($40)
    3. Business / Professional ($75)

    1. Individual Lifetime ($225)
    2. Husband / Wife Lifetime ($350)
17. Additional Tax-Deductible Donations

    1. Ozaukee county Pioneer Village Restoration
    2. Interurban Depot to Interurban Depot Restoration
    3. Archives Research Center
    4. Stony Hill School

    1. Harold Dobberpuhl Memorial Scholarship
    2. Use Where Needed
    3. Memorial*
19. *
    Who shall the memorial be to?
21. Can You Help Volunteer?

    1. Yes

    1. No

    Ozaukee County Historical Society can use all the help it can get.
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field