Highland County Senior Citizens Center Membership
Please fill out and submit the form below. Need help? Call 937-393-4745
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Name *
Spouse Name
if applicable
Home Address *
Mailing Address
if different
Phone Number *
Emergency Contact Name & Telephone *
Doctor Name & Contact
Birthday
Month & Day
Spouse Birthday
if applicable
Interested in Volunteering?
Winter Address & Dates Gone
if applicable
Please Mail Your Check
After you submit this form please mail your check to the Highland County Senior Center, 185 Muntz Street, Hillsboro, OH 45133

Regular Membership: Ages 50+ = $20.00
Associate Membership: Ages 21-49 = $25.00
Lifetime Membership: Ages 90+ = FREE
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