Membership Form

Name:____________________________________________________________________

Address:___________________________________________________________________

Phone:____________________________________________________________________

Email:____________________________________________________________________

Type of Membership:

_________ Single ($12.00)

_________ Family ($20.00)

_________ Patron ($50.00)

_________ Gold Patron ($100.00)

_________ Diamond Patron ($101.00 +)

Please mail along with you check to:

Elk County Historical Society

P. O. Box 361

Ridgway, PA 15853

Thank you!