Membership Sign-Up

Complete the form below to become a lifetime member of National Dairy Shrine. A $50 one-time fee must be sent to our office at: National Dairy Shrine, P.O. Box 1, Maribel, WI 54427 in order to complete the membership process.

Fields with (*) are required.
* Name:	(Please print your name exactly as you want it to appear on the membership certificate.)
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* Email Address:
Affiliation:	(Optional designation of company/organization)
* Please send the newsletter to my: (check one) Email Address Regular Address
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