4729 Walnut Road, Buckeye Lake, Ohio 43008.
APPLICATION FOR MEMBERSHIP
Greater Buckeye Lake Historical Society
P.O. BOX 1
Buckeye Lake, Ohio 43008
Date______________________
Name___________________________________________________________________________________________________
Address________________________________________________________________________________________________
City_________________________________________ State_______________________________ Zip_____________
Home Phone__________________________________ Cell Phone____________________________________
Email Addres________________________________________________________________________________________
Work/Business_____________________________________________________________________________________
Memberships are for one year.
Membership Category:
Individual $25 Couple or Family $35 Organization or Business $75
Lifetime: (One Time Payment) $500
Additional Comments & What Talents Would You Like to Contribute:
Please print and fill out this form and send with a check to the address above.