LTHS Annual Membership Application

LTHS Annual Membership / Donation

Lake Township Historical Society
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Phone Number

Area CodePhone Number
Membership - One Year*
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Family$20.00

Individual$10.00

Donation$5.00

Quantity

Total $0.00
I wish to pay by:*

PaypalCheck / 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