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MEMBERSHIP

Mid America Geographic Foundation

To become a member or renew membership please print this form.

Fill in the blanks and send to the address below. Please enclose your check made payable to

Mid America Geographic Foundation and mail to the following address:

Mid America Geographic Foundation

P.O. Box 722 99W 2nd St

Fond du Lac, WI 54935

Name_______________________________________________________________

Address_____________________________________________________________

City_______________________________ State____________

Phone_____________________________

Email______________________________

Type of membership:

Amount

Individual

$15.00

Individual senior (age 62)

$10.00

Family (children included)

$25.00

Student (includes adult with student ID)

$10.00

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