Application For Membership

RIPLEY HERITAGE MUSEUM, Inc.

P.O. Box 176
Ripley, OH  45167
(937) 392-4660

 
  Individual Annual Dues -    $10.00    Patron Dues (Organizations, Businesses) - $25.00 & Up
  Junior Membership Dues - $5.00 (17 & Under)   Individual Life Membership -                     $100.00
  Family Annual Dues -        $20.00


Date:  _______________________________ If Family Membership please list all members
Name _______________________________ ____________________________________
Address  _____________________________ ____________________________________
              _____________________________ ____________________________________
Phone     _____________________________ ____________________________________

Please Print This Form, Fill In Information, and Mail it to the Address Above
Make all checks payable to: Ripley Heritage, Inc.