Membership Form

Membership fees support the work of the Society,

including three newsletters per year.

Name: ____________________________________________

Street Address: __________________________________________

City: _______________________ State: _______ Zip: _______

Telephone: ( ) _________________

E-mail: _________________________

Church membership: ______________________________

Are you the Church Historian for your church? Yes _____ No _____

Conference membership:

East Ohio _____ West Ohio _____ Other ________

UMC District: __________________

Regular Membership ($15.00) _____

Student Membership ($5.00) _____

Memorial Life Membership ($150.00) _____

Given in memory of: ____________________________

Life Membership ($150.00) _______

Memorial and Life memberships can be paid in quarterly installments of $37.50. Do you want this option? Yes _____ No _____

Amount enclosed: $__________

Please make checks payable to UMHSO. Send membership form and check to:

Charles R. "Rudy" Heath

6586 Fields Ertel Rd.

Sharonville, OH 45241-1367

Questions? Contact Sandy Nihiser, kensln@roadrunner.com