Call To Liberty Membership Form

       You are invited to become a member of the Call To Liberty Association

     Please complete this form and return with check for 15.00 per member payable to

Call To Liberty Association

2567 W St. Rt. 29

Urbana, Ohio

43078

Name:___________________________________

Address:_________________________________

City, State, Zip:_____________________________

Phone #:_________________________________

Email:___________________________________

Please list any experience or special skills that might pertain to

pre-1840 history.

_______________________________________________

_______________________________________________

Thank you for your membership and support.

Any questions or comments please call

Chris Callison

937-652-4666