GOHS Membership Application

Please use your browser's Print command to print this page, fill out all the fields below, enclose your check or money order for ONE* or TWO years dues, payable to: GOHS and drop this form in the mail to:

GULFOIL HISTORICAL SOCIETY
9710 Co Rd H
Delta, Ohio 43515

Last Name:

First Name:

Address 1

Address 2

City:

State:

Zip:

Country:

Phone:

Email:

Select Membership Term:

One year $40.00   ___

Two years $78.00 ___

One year, Canadian residents $43.00 ___

One year, all other countries $48.00 ___

Additional family members, same address, @ $20.00 each

Name __________Relation____________

Name __________Relation____________

Name __________Relation____________

* All non-US memberships are for a maximum of ONE YEAR, due to the instability of postage rates.

Thanks for Joining GOHS!!!

Your personal information will be kept strictly confidential. Personal information that you submit will not be sold or used by anyone other than GOHS. We do not allow our customer information to be used for unsolicited contact.
PLEASE NOTE: We do publish membership information in each newsletter, so that members may write to, and phone each other at their will. If you do NOT wish to have your information published with the others, please check here: ____

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