Membership Form
Membership Application For Last Name: _____________________ First Name: ______________________ Date: ______________ Address: ____________________________________________________ Phone: ________________________
Membership Level: ______________________________ E-Mail address: _______________________________
Signature: _______________________________________________ Yearly Membership levels: Seniors (55 plus) $25.00 Individual $30.00 Family $35.00 Lamplighter $100.00 Keeper $250.00 Grand Keeper $1000.00
Mail membership application and fee to: Ashtabula Lighthouse Society P.O. Box 221 N. Kingsville, Ohio 44068 |
|
|
