Annual Memberships September 1, 2010 thru August 31, 2011
___Individual	$10.00
___Family	$20.00
___Student	$ 5.00
___Organization	$25.00
Name__________________________
Adress_________________________
City___________________________
State__________________________
Zip____________________________

Fill out form and send it along with a check for the amount payable to:
Lucy Hayes Heritage Center
90 West Sixth Street
P.O. Box 1790
Chillicothe, Ohio 45601
740-775-5829