Date____________________________

Amount enclosed  $ ____________________

Renewal__________________

New member_____________

Annual membership categories

Benifactor             $500.00

Donor                   $ 200.00

Patron                  $100.00

Sponsor                $50.00

Friend                  $25.00

Name___________________________

Address_________________________ ________________________________ ________________________________

Just print form and fill out then mail to:

Lonoke County Museum P.O.Box 873 Lonoke Ar 72086

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