Membership Form

Check One

New Member

Renew Membership

1. • Individual  $15.00
   

2. • Family  $25.00
   

3. • Non-profit Organization $50.00
   

4. • Business $75.00
   

5. • Preservation Advocate Bronze Star  $100.00
   

6. • Preservation Advocate Silver Star  $250.00
   

7. • Preservation Advocate Gold Star  $500.00

Annual Fee

Name                                                                                  

Address                                                                               

City                                            State                                       Zip                             

Phone (         )          -                                            E-Mail Address                                        

Print page and return with your check made payable to:

Lebanon Conservancy Foundation Inc. 

P.O. Box 893   Lebanon, OH  45036