This Form Can Be Used To Join or To
Donate To The
Sycamore Historical Society
Go to your browser's "File" menu to print a copy
of this form. Mail application and payment to address shown.
SYCAMORE HISTORICAL
Box 502
Sycamore, IL. 60178
Membership Application
Date _____________________
Name
______________________________________ Spouse Name
________________________
Address
_________________________________________________________________________
City
_____________________________ State
___________________ Zip ___________________
Phone
________________________________________________
Email Address __________________________________________
Individual
( ) $15.00
Annual
Family
( ) $25.00
Annual
Lifetime
( ) $150.00 One
Time Only
Student
( ) $5.00 Annual
(Individual and if full time student under 18 yr. old)
Already a Member but Wish to:
___ This is a renewal (see renewal date on mailing address label)
___ As Charter One-Year Member, add $90.00 for Lifetime
Membership
___ Give Membership to Another as a Gift (Please give recipient's
information above)
___ Payment includes a donation of $_______________ over/above Membership
cost.
___ Pass this form on to a friend, neighbor or business
Would you like to be on a
committee? Yes
(
)
No (
) Maybe
( )
Would you like to be an
officer?
Yes (
)
No (
) Maybe
( )
Museum
Helper?
Yes (
)
No
Do Not Wish To Be A Member But Wish To Donate
___ To Museum
Fund
$ ______________
___ To Operational Expenses $ ______________