West Lincoln Historical Society Membership Application

Box 797
288 Station Street
Smithville, Ontario, Canada L0R2A0

Be a part of history: share the memories of our past, present and future.

    First Name (required)

    Last Name (required)

    Member Number-for renewals only

    Street Address (required)

    Mailing Address

    City (required)

    Province/State (required)

    Postal/Zip Code (required)

    Country (required)

    Telephone Number (required)

    Email (required)

    Membership Dues:
         Individual - $10.00 per year
         Family (at same address)- $15.00 per year

    RenewalNew Member

    Membership Payment

    Additional Donation

    Total Remittance

    Please make cheque or money order payable to: West Lincoln Historical Society

    Send to above address

    Your Message