•

MEMBERSHIP FORM

To become a member of the Jewish Historical Society of Michigan, please enter your information below, print and mail form with enclosed check to:
Jewish Historical Society of Michigan
6600 W. Maple Road
West Bloomfield, MI 48322-3003

Please select one from the following:
	$36	Individual/Family/Institution/Organization
	$18	Young Adult (30 years old or younger)
	$100	Corporation/Foundation
	$360	Life Member
	Heritage Council Endowment(s) — Donors of $600 and up to the Heritage Council automatically become life members.
Please select one from the following:
Membership Renewal   New Member
Member Information:
First Name:		Last Name:
Address:
City:
State:		ZIP Code:
Home Phone:		Work Phone:
E-mail:		Fax:
Membership Amount: $ Dues are tax-deductible.