Request / Donation Form

You may use this form for the following types of donations/requests. Please review the description and information for each category on the guidelines page.
    o Artifact Donation
    o Charitable Donation
    o Volunteer
    o Newsletter (membership required)
    o Membership Pledge
    o Other (LCHS Wish list fulfillment)

Name:

Address

City

State ZIP

Phone:

Email Address

Request Type

Artifact Donation

Charitable Donation

Membership Pledge

Other (LCHS Wish list fulfillment)

Newsletter
(membership required)

Volunteer Type

Membership Pledge

$15 Student

$40 Family/Couple

$20 Single Senior (60+)

$100 Contributor

$25 Individual

$250 (or above) Patron

A membership form will be mailed to the address listed above.

Description of Artifact or Wish List items that you would like to donate. If a Charitable Donation, please state the pledged amount of donation and on behalf of what person and/or organization
Please review the guidelines for assistance in filling out this section.

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