Use this form only to pay by check. If you want to pay by credit card, use our online payment form.
Print out this page, fill out the application, and mail it with a check payable to Lincoln Highway Association to:
Lincoln Highway Association
Jeff Lotze, Treasurer
2835 Maplegrove Ave
Louisville, OH 44641-9635
Date: ____________________ Annual membership is from date of enrollment.
◯ New Member ◯ Renewal
Membership Categories:
|
◯ Student: $25 ◯ Individual: $45 ◯ Family: $60 ◯ Supporting: $75 ◯ Patron: $150 ◯ Life: $1000 and up |
◯ Non-profit organization: $45 ◯ Local, county, and state governments: $45 ◯ Business: $75 ◯ Corporate: $150 |
Additional donation (optional): $ _______________
State Affiliation
| Members who live in Lincoln Highway states are automatically members of that state’s chapter. Dues for additional chapter memberships are $9.00 per year per state. Check the appropriate box. |
▢ NY ▢ IL ▢ NV |
▢ NJ ▢ IA ▢ CA |
▢ PA ▢ NE ▢ At large |
▢ OH ▢ WY |
▢ IN ▢ UT |
Total amount by check: $_______________
Please Print
|
|
||||||||||||||||||||||||||||||||||||
The Lincoln Highway Association is exclusively charitable and educational, within the interpretation of Section 501(c)(3) of the Internal Revenue Code.