Name:
Address Line 1:
Address Line 2:
City:   State: 
  Zip Code:

  Day Time Phone Number:
 Evening Phone Number:

  Email:

 I wish to join the The Highland Area Historical Society!

  Payment Information:
        Make Check payable to: Highland Area Historical Society

   $15.00 for an individual or family
   $75.00 for a Sustaining Sponsor
   $7.50 for a Historic District individual or family
    $37.50 for a Historic District Sustaining Sponsor    

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