Application for Membership

Name (please print)

______________________________________________________________
Address

______________________________________________________________
City

______________________________________________________________
State

______________________________________________________________
Zip code (or postal code and country if not U.S.)

______________________________________________________________
Amount enclosed

$20 ____    $35 ____    $50 ____    $75 ____    $100 ____    Other ____

$2.50 Note Cards (pkg of 5) ____    $1.00 Lapel Button ____

The National 19th Amendment Society is a non-profit organization. Contributions

above the $20 membership level are tax-deductible as allowed by law.

Send to:

National 19th Amendment Society
P.O. Box 33
Charles City, IA 50616

For more information, email us or call (641) 228-3336 . Thank you for your support!