WAUCONDA TOWNSHIP HISTORICAL SOCIETY MEMBERSHIP
NAME HOME PHONE
ADDRESS
CITY/STATE/ZIP
WORK (or CELL) PH. _____________________
E-MAIL _____________
MEMBERSHIP: ANNUAL DUES: (JANUARY 1 - DECEMBER 31)
TYPE OF MEMBERSHIP :
STUDENT ($ 2.00) INDIVIDUAL ($ 10.00)
FAMIL Y ($15.00) _ SUSTAINING ($ 25.00)
BUSINESS ($ 50.00)
LIFE (INDIVIDUAl) ($100.00) LIFE (FAMILY) $150.00
MAKE CHECKS PAYABLE TO : WAUCONDA TWP HISTORICAL SOCIETY
MAIL CHECK & MEMBERSHIP FORM TO:
WAUCONDA TWP HISTORICAL SOCIETY
P.O.BOX256
WAUCONDA, IL 60084