TRI--COUNTY TRIANGLE TRAIL MEMBERSHIP APPLICATION

Name __________________________________________________   

Street ________________________________________________

City ________________________ ST  ______ Zip __________

Home Phone (   )____________     Work(   )_____________

Email _______________________________________

(We value your privacy and will not release information to others

without your permission!)

Family Membership (one vote per family)

List other family names:

________________________________________

________________________________________

________________________________________

________________________________________

________________________________________

1) Annual Membership is $10.00 per individual or family                 

2) Make checks payable to Tri-County Triangle Trail, Inc.            

   Contribution is tax deductible             

3) Mail to:

Tri-County Triangle Trail

P. O. Box 887               

Chillicothe, OH 45601

___ I would like to make an additional contribution to the trail.

___ I would like to make a memorial contribution to the trail.

    In memory of ____________________________________.

4) Receive in return mail your membership cards