SYCAMORE  HISTORICAL SOCIETY             
   Box 502
   Sycamore, IL. 60178

   Membership Application                                                     

   Date _____________________

   Name _______________________________  Spouse Name ________________________
   Address __________________________________________________________________
   City ___________________________ State ______________  Zip ___________________ 
   Phone ________________________________________________
   Email Address __________________________________________

     Type of Membership Desired

   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 (   )            Maybe (   )

   Do Not Wish To Be A Member But Wish To Donate

   ___ To Museum Fund              $ ______________
   ___ To Operational Expenses   $ ______________