Date: ________________
Name: ________________________________________________
Address: ______________________________________________
Town, State, Zip: _______________________________________
E-Mail: ______________________________________________
Dues (Check type of Membership desired):
______ Single - $20.00/year
______ Single Life - $200.00
______ Family - $24.00/year
______ Family Life - $250.00
______ Contributing - $32.00/year
______ Sponsor Life - $300.00
______ Patron - $50.00/year
______ Special (over 65 or student under 21) - $16.00/year
Status:
______ New membership
______ Charter Member
______ Renewal of membership
Mail to: Jackson County Historical Society, Murphysboro, Illinois 62966
Please enclose a SASE if you want a membership card mailed to you.
Members living in foreign countries please add $6.00 for Newsletter
postage.
