INDIVIDUAL MEMBERSHIP - ANNUAL   _____ X $10.00
January - December

NAME: _______________________________________________________

STREET: ______________________________________________________

CITY: ________________________________________________________

STATE: ________   ZIP: _____________

PHONE: (      ) ______________  EMAIL ADDRESS: ______________________

Method of Payment: 
Check ___  
Money Order ___ 
Cash ___  only accepted in person at monthly meetings

Please make check/money order payable to:

West Jefferson Hills Historical Society

and mail to following address:

West Jefferson Hills Historical Society
c/o Jefferson Hills Municipal Building
925 Old Clairton Road
Jefferson Hills, PA 15025

For More Information, please contact:

Jefferson Hills Library (412) 655-7741