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*

Please choose a payment method from the dropbox below.

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Name

This field is for validation purposes and should be left unchanged.