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WHO Membership Form

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Saved by Debbie Cardinal
on May 10, 2011 at 1:12:24 pm

Wisconsin Heritage Online – Membership Dues *

FY12 (July 2011-June 2012)

Large organization $100

Small organization $ 50

Each institution determines whether they are large or small. For-profit organizations are invited to join at the $100 level.

Name of Institution: __________________________________________

Street Address: __________________________________________

City/State/Zip: __________________________________________

Contact Person: __________________________________________

Email address: __________________________________________

Phone: __________________________________________

We will join/renew Wisconsin Heritage Online in the ___LARGE___SMALL category.

_______ Please send invoice.

_______ A check is enclosed. Make check payable to Wisconsin Library Services.

_______ Remove from deposit account.

RETURN to:

Wisconsin Heritage Online, 728 State Street Room 464, Madison, WI 53706

FAX: 608.262.6067

or email to Shirley Schenning, schenning@wils.wisc.edu

* The figures above are suggested contributions. Please give what your budget can handle. Thank you!