LTHS Annual Membership Application

LTHS Annual Membership / Donation

Lake Township Historical Society
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail
Phone Number

Area Code Phone Number
Membership - One Year *
prev next ( X )
Family $ 20.00

Individual $ 10.00

Donation $ 5.00

Quantity

Total $ 0.00
I wish to pay by: *

Paypal Check / Postal Order (Please make payable LTHS)
Mail To: Lake Township Historical Society

Attention: Membership

PO Box 482, Uniontown, OH 44685
Should be Empty:

LTHS Annual Membership / Donation