Fill out this form, print it and mail
it with your check or money order to:
DuBois Family Association
C/O
Fred DuBois
4296 Jennings Fish Camp Road
Lake Wales, FL 33898
Membership is open to anyone who is
interested in preserving the work of historical interest and education on Huguenot Street and of the
DuBois family specifically.
If possible, please include your family
tree as far back as you can.( Father, Grandfather, Great grandfather etc.) printable form
I wish to join the DuBois Family
Association
in the membership level listed below.
--------------------
Individual,
one year $20
Individual,
three years $50
Household
(two adults), one year $30
Household
(two adults), two years $50
Family(2
adults,3 children) one year $60
Contributor,
one year $50
Donor,
one year $100
Patron,
one year $500
*Other Contributions:
(enter dollar amount)
General Fund:$
Fort Fund:$
Endowment Fund:$
______________________
total Contributions :$ total Dues :$
GRAND TOTAL :$
* for an explanation of the types of funds contact
finance officer at finance@dbfa.org
