MEMBERSHIP APPLICATION

(January 1 thru December 31)

 

YEARLY MEMBERSHIPS

  Individual     $  12.00   __________

   Family          $  18.00   __________

Sustaining     $   50.00    _________

Contributing   $ 100.00  __________

 

LIFE MEMBERSHIPS

Life - Single   $   250.00  ______________

Life - Couple  $  450.00  ______________

Patron *          $ 750.00  ______________

Benefactor *  $1,000.00  ______________

* Patron and Benefactor deposited in investment fund to benefit the society

 

NAME ___________________________________________________________________________________

ADDRESS  ________________________________________________________________________________

DATE ____________________________                        AMOUNT SENT  _____________________________

SEND TO:  The Troy Historical Society  100 W. Main St., P. O. Box 401, Troy, OH 45373-0401