Membership / Donor Form

Name *

First

Last

Email

Address *

City, State, Zip *

Phone Number (home, cell, work ?) *

Membership

• Individual $ 25.00
• Couple $ 40.00
• Non-Profit 501(c)3 Business $ 35.00
• Business $ 50.00

In addition to my membership, I would like to donate….(please state amount)

Payment Method

• I will mail a check payable to Brush Creek Mill at P.O. Box 344, Hillman, MI 49746
• I will pay by credit card (+3.3% service charge)

Credit Card Information (Name on card, number, exp. date, CVS)

Are you interested in volunteering?

• Yes, please contact me
• Maybe, please contact me
• Not at this time
• I am interested in being involved with the Historical Society

Additional Information (names, addresses, emails, phone numbers, dates to use each address, etc.)

Submit