2022 Membership Form Step Start Previous Next Name * First Last Primary Phone * Email Address * (used for meeting notices, board meeting materials, other information) To opt-out of receiving monthly board meeting materials via email, check this box Check Here Address Field * Address Line 1 * Address Line 2 City * State * Zip Code * Click the "NEXT" button to your right to continue Alternate Address & Phone # Previous Next (Skip if not applicable) Dates this contact information should be used in place of information provided on front of form: Alternate Address Address Line 1 Address Line 2 City State Zip Code Alternate Phone Number Email Address Click the "NEXT" button to your right to continue Membership Class/Level Previous Next Membership Class/Level * Museum Individual, One Year, $15 - $15.00 Museum Couple/Family, One Year, $25 - $25.00 Museum Business, One Year, $50 - $50.00 Museum Individual/Couple/Family, Lifetime, $400 - $400.00 Museum/ODHA Circle-Individual, One Year, $25 - $25.00 Museum/ODHA Circle-Couple/Family, One Year, $35 - $35.00 Museum/ODHA Circle-Business, One Year, $50 - $50.00 Museum/ODHA Circle-Individual/Couple/Family, Lifetime, $500 - $500.00 Additional Contribution (please fill in amount): $ Total Amount of Gift. You may specify break down below if you wish. IT IS NOT REQUIRED Capital Campaign Fund Amount General Operating Fund Heritage Village Fund This gift is in memory of: Free ODHA T-Shirt for Lifetime ODHA Circle Members Small Medium Large X Large XX Large XXX Large (Choose Your Size) Total $ 0