ONTARIO COUNTY HISTORICAL SOCIETY ONLINE MEMBERSHIP APPLICATION

Your payment may be made with any valid credit card or PayPal account and will be processed by PayPal.

MEMBER INFORMATION

Member's First Name *

Member's Last Name *

Prefix *

Member's Name in Full (as to appear exactly on membership card) *

Member's Address *

City *

State *

Zip Code *

Phone Number *

Member's Email Address *

Bill to: First Name *

Bill to: Last Name *

Prefix *

Billing Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Please choose your membership level

*

Centennial ($100)	Family ($75)
Individual ($40)	Individual Senior ($35)