The Coalition of Historical Trekkers

Membership Application

The following rates are for a full One (1) year membership, due in June.	If joining at some other time of the year, please use the prorated schedule below:
$25/year Individual Adult Membership $35/year Family Membership (includes children up to 18 yrs. old) $15/year Youth Membership (For those under 18 years old whose parents or legal guardians are NOT members of the CoHT)	June, July, August - Individual Adult $25, Family $35, Youth $15 Sept, Oct., Nov. - Individual Adult $18.75, Family $26.25, Youth $11.75 Dec., Jan., Feb. - Individual Adult $12.50, Family $17.50, Youth $7.50 Mar, April, May - Individual Adult $6.25, Family $8.75, Youth $3.75

Mail this completed form along with your check or money order
made payable in US funds to:COHT

Mail to:

COHT
c/o Membership Director

Jim "Wart" Perkins

P.O. Box 172

Warsaw, OH 43844

Please allow 4 to 6 weeks for delivery

Youth Membership Family Membership Individual Family Membership
Renewal Change of Address
Please include my contact info. in the COHT’s National Members Register
( This Register is published quarterly in each Issue of our national magazine, The Time Traveler's Gazette )

(Type or Print Clearly)

Name:

Address:

City:

State:
Zip:

Phone:

Fax:

Email:

Family Memberships Information

Spouse
Children

Brief Description of Persona
( region, time period, etc.)
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