One Time Payment Annual Membership

To become a member of the Clark County Historical Society, please select from below:

Note: If you wish you give beyond the amount listed in the dropdown, please call (937) 324-0657.

Name(Required)

First Last

Email(Required)

Phone

Gift A Membership

Please check the box and enter the name and residence of the membership recipient. (You will still get a receipt for your purchase!)

Yes, I'd like to gift a membership.

Recipient Name(Required)

First Last

Address(Required)

Please enter the mailing address for your membership card or the gifted membership card.

Street Address City State ZIP Code

Are you joining as a corporate member?

Please check the box if you are interested in becoming a corporate member.

Yes, I'd like to join as a corporate member.

Membership Level(Required)

Please choose a membership level from the dropdown box.

Membership Level(Required)

Please choose a corporate membership level from the dropdown box.

Membership Dues

Payment Method(Required)

Please choose a payment method from the dropbox below.

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Comments

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