Highland County Senior Citizens Center Membership
Please fill out and submit the form below. Need help? Call 937-393-4745
Name *
Your answer
Spouse Name
if applicable
Your answer
Home Address *
Your answer
Mailing Address
if different
Your answer
Phone Number *
Your answer
Emergency Contact Name & Telephone *
Your answer
Doctor Name & Contact
Your answer
Birthday
Month & Day
Your answer
Spouse Birthday
if applicable
Your answer
Interested in Volunteering?
Winter Address & Dates Gone
if applicable
Your answer
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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