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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