Lincoln Highway Association
Join, Renew, or Donate by Check

Use this form only to pay by check. If you want to pay by credit card, use our online payment form.

Print out this page, fill out the application, and mail it with a check payable to Lincoln Highway Association to:

Lincoln Highway Association — Treasurer
P.O. Box 1326
Delaware, OH 43015

Date: ____________________    Annual membership is from date of enrollment.

◯ New Member        ◯ Renewal

Membership Categories:

◯ Student: $25
◯ Individual: $45
◯ Family: $60
◯ Supporting: $75
◯ Patron: $150
◯ Life: $1000 and up
◯ Non-profit organization: $45
◯ Local, county, and state governments: $45
◯ Business: $75
◯ Corporate: $150

Additional donation (optional): $ _______________

State Affiliation

Members who live in Lincoln Highway states are automatically members of that state’s chapter. Dues for additional chapter memberships are $9.00 per year per state. Check the appropriate box. ▢ NY
▢ IL
▢ NV
▢ NJ
▢ IA
▢ CA
▢ PA
▢ NE
▢ At large
▢ OH
▢ WY
▢ IN
▢ UT

How many years of membership do you want to pay for (up to 4)?
If you pay for 2 or more years, you will get a $5 discount per year.
____ (up to 4)

Total amount by check: $_______________

Please Print

Name ____________________
Address ____________________
City _________ State __ Zip _____
Home phone (__) ___________
Work phone (__) ___________
E-mail address ______________

The Lincoln Highway Association is exclusively charitable and educational, within the interpretation of Section 501(c)(3) of the Internal Revenue Code.