NORTH CANTON HERITAGE SOCIETY

MEMBERSHIP APPLICATION FORM

___ Yes, I (we) want to support the work of the North Canton Heritage Society. 

Please mark the appropriate category indicating the type of membership you prefer, and make checks payable to The North Canton Heritage Society.  Call us at 330.494.4791 or e-mail us if you have any questions. 

_____  Senior Citizen (age 65 or older) Donation       $________

_____  Student (full time thru age 23)                        $5                       

_____  Supporter                                                     $24

_____  Patron                                                          $50 to $99

_____  Sustaining                                                     $100 to $249

_____  Benefactor                                                    $250 or more

Name(s):            ___________________________________________________

Address:            ___________________________________________________

                         ___________________________________________________

Phone (include area code):             _____________________________________

E-mail address:            ______________________________________________

Send this form with your check to The North Canton Heritage Society, 200 Charlotte Street NW, Suite 102, North Canton, OH  44720.  Members’ names will be listed in our newsletter, the Patchwork Quilt, unless you notify us otherwise.

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