Membership Application

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To join the Historical Society, print out and complete the form.

Mail it with your check or money order to the address on the form.

YOU ARE CORDIALLY INVITED TO JOIN

THE HISTORICAL SOCIETY OF GERMANTOWN

New and renewal memberships will be accepted by mail or at the headquarters of the Historical Society, corner of Plum and

Center Streets. Thank you for helping maintain the museum and helping to continue the programs of historic preservation,

collections, exhibits and education.

ANNUAL MEMBERSHIPS; DUES PER ANNUM

1. Individual ............................................................................................................................................$10.00

2. Student (applicable to all school age children and full time college students) ............................Complimentary

3. Business/Organization ....,................................................................................................................$50.00

4. Family (parents or guardians and their legal dependents under age 18) ...................................$20.00

5. Supporting (individual or family) ......................................................................................................$100.00

CONTINUING MEMBERSHIP ONE-TIME CONTRIBUTION

1. Life (individual) ..................................................................................................................................$ 500.00

2. Patron (individual) .............................................................................................................................$1,000.00

Annual memberships of any category shall run from January 1 to December 31. Membership fees are deductible for income

tax purposes. The membership cards will be mailed.

NAME________________________________________________ STREET_________________________________

CITY ____________________________________________STATE__________ ZIP___________

TYPE OF MEMBERSHIP_____________________ TELEPHONE__________________________

CASH_______________ CHECK NUMBER___________ FOR YEAR_______________________

List names (and ages of children) to appear on family memberships.______________________________________________

__________________________________________________________________________________________________

I would like to participate in the future direction of activities at the Historical Society and would especially like to help in the following

areas:______________________________________________________________________________________________

I would like to become an officer in the Historical Society _____YES _____NO

The Historical Society of Germantown wishes to thank you for your membership. MAIL TO:

The Historical Society of Germantown

P. O. Box 144

47 W. Center Street

Germantown, OH 45327-0144