Individual - $12 + $6 for any other member of the same household.

Student - $2 for any student enrolled in school and under 21 years of age.

Benefactor - $250          Patron - $100          Friend - $50

Please circle the membership level above, make your check payable to and return with this form to: Chattahoochee Valley Historical Society, Inc.

3419 20th Avenue, Valley, AL 36854

DATE: ______________

NAME:_______________________________________    AMOUNT: _________   

STREET: ________________________________________________________________

CITY: ________________________________   STATE: _______   ZIP CODE: _________