The Grandview Heights / Marble Cliff Historical Society
                                         1685 West 1st Avenue
                                         Co1umbus OH 43212

MEMBERSHIP APPLICATION                 Date_______________________

Category:  New_____  Renewal_____  Single_____  Couple_____  Organization_____

Please print or type the following information:

Tit1e(s) & Name(s) 
as preferred for 
mailing address____________________________________________________

Address_________________________

City_______________State____ZIP_____

Given name(s) if
not shown above___________________________________________________

Telephone: Home__________  Business ____________

E-mail address________________________________

Membership payment - Checks should be made payable to: 
The Grandview Heights - Marble Cliff Historical Society. 
Please check the appropriate category.
                                                                    Life                 
                                                  _________________________________
                                Annual        Regular        Patron*       Benefactor*
                                ______         ______        _______        __________

          Single              $10___         $ 100___       $ 500___       $ 1,000___
          Couple              $15___         $ 150___
      Organization            $15___
                                                           * May involve non-cash contributions, 
                                                              subject to arrangement with the 
                                                               Board of Trustees


__________________________________________________________
The following space for use only by treasurer.                    
Received__________       New__________        Year__________  
Recorded__________       Renewal__________     No.__________  

rev:7/99