Brookville Historical Society, Inc.

Membership Application
Membership year is June 1 - May 31
Categories or levels

 Annual dues except for lifetime individual membership

Individual . . . . $ 10.00 - one adult membership
Student . . . . . . $ 4.00 - single membership for student to age 18
Family . . . . . . $ 20.00 - immediate family residing in same household
Sustaining . . . . $ 25.00 - individuals who wish to give further support
Lifetime . . . . $ 100.00 - one-time payment for individual membership
Business/Professional $ 25.00 - includes two membership cards
Corporate . . . . $ 150.00 - includes five membership cards

Please make check or money order payable to

Brookville Historical Society, Inc.
P. O. Box 82
Brookville, OH 45309-0082

Please print, complete form below and mail with check or M. O.

Name    
 
Address    
 
City   State   Zip Code +4  
 
 
 
Membership Category *  

* Family membership - please list names of individuals in household

Additional notes or comments