Kishwaukee Valley Heritage Society
Membership Form
Instructions: Print this page. Mail
completed form and your payment to
Kishwaukee Valley Heritage Society
622 W. Park Avenue
Genoa, IL. 60135
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Membership Form New _____ Renew _____ I would like the following membership: ( ) Individual Membership $10.00 Date ___________________________________________ ( ) Family Membership $15.00 Name(s) ________________________________________ ( ) Sustaining Membership $25-$100.00 Address ________________________________________ ( ) Business Membership $25-$100.00 City ____________________ State _____ Zip _________ ( ) Lifetime Membership $1,000.00 Phone ( ) _______________________________ E-mail _________________________________________ Amount Enclosed $__________ I would Consider:
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