Amana Heritage Membership Form

Name___________________________________________________________________

Address_____________________________________________________________

City:______________________________

State:_________Zip:_______ - ________ Phone #___________________________

Membership fees:
(as of September 2007)

$20.00 Individual
$25.00 Family
$35.00 Contributing
$100.00 Patron

Mail form and payment to:

Amana Heritage Society
PO BOX 81
Amana, IA 52203

Phone: 319-622-3567