Centerville-Washington Township Historical
Society
89 W. Franklin St.
Centerville, OH 45459
Membership Application
| Name | |||
| Address | |||
| City | State | Zip | |
| Phone | |||
| Categories of Membership (check one) | |
| □ Individual | $25.00 |
| □ Family | $35.00 |
| □ Business | $50.00 |
| □ Friend | $100.00 |
| □ Patron | $250.00 |
| □ Supporter | $500.00 |
| □ Benefactor | $1,000.00 |
| □ Annual Gift |
$________ |