First Name:		
Last Name:              
Address:		
Address:		
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Telephone:	       () 
E-mail Address:		
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Yes, I want to be a member of the Dinsmore Homestead at the following level:
   GENERAL MEMBERSHIP LEVELS
  $20 Student/Senior Citizen 
  $35 Individual
  $60 Family
 $100 Friend 
   JULIA DINSMORE SOCIETY LEVELS
 $250 Supporter
 $500 Patron
$1000 Sustaining - check here to be billed quarterly  
$2500 Benefactor - check here to be billed quarterly 
Contribution only, no membership - please indicate amount: $.00

I wish to use my:
 Visa/MasterCard  For your security, Please CLICK HERE for printable
                     credit card form.
 Check (make payable to Dinsmore Homestead)

Mailing Address for check or credit card payments:
Dinsmore Homestead Foundation
P.O. Box 453
Burlington, KY  41005

How did you find the Dinsmore web site?


Any questions or comments?

 
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