Today's Date: _______________
   
Your Name: __________________________________
   
Mailing Address: __________________________________
   
Email Address: __________________________________
   
Your Contribution Amount: $ _____________
   
  Thank You!

Please print out this form and mail it to:

Ottawa County Historical Society
P.O. Box 385
Port Clinton, OH 43452


Please make checks payable to: Keeper's House, O.C.H.S.