Please fill out the Membership Application below, then click on
the "Submit Query" button at the bottom, to pay for your Membership.
On-Line Membership Application
Name
Address
City
State
Zip Code
Home Phone with Area Code
Work Phone with Area Code
Cell Phone with Area Code
Your E-Mail Address
Referred by
Additional Comments or Talents you would like to Offer the Society.
Please Choose the type of Membership requested.
Individual $25
Couple or Family $35
Organization or Business $50
Lifetime (One Payment) $500
If you have any problems with this form, please send an e-mail to
j-me@buckeyelakehistory.org
