Lincoln Society of Virginia Membership

_______  I would like to become a member of the Lincoln Society of Virginia for 2011

_______  I would like to renew my membership in the Lincoln Society of Virginia for 2011

I have enclosed my dues:   _______ $20 per individual    _______ $25 per couple/family

 (Make check payable to:  Lincoln Society of Virginia)

Name(s) and Address (please print):         Phone No:

__________________________________________          _______________________________________

__________________________________________          _______________________________________

__________________________________________       Email Addresses:

__________________________________________          _______________________________________

__________________________________________          _______________________________________

Send form and check to:   Elaine C. Dellinger

                                      Lincoln Society of Virginia

                                      Bridgewater College

                                      402 E. College Street

                                      Bridgewater, VA  22812

                                      540-828-5620   /   edelling@bridgewater.edu