GM&O Historical Society Membership and Renewal Form

Current membership payments are for the 2012 calendar year. 

 

_____ Regular Membership @ $30.00

_____ Senior Membership (65+) @ $25.00

_____ Sustaining Membership @ $50.00--$99.00

_____ Benefactor Membership @ $100.00 or more

***International memberships, please add $15 to chosen membership class to cover additional postal expenses.  Canadian members need only add $10 for cross border mailings***

 NAME ________________________________

 ADDRESS ______________________________

 CITY _________________________________

 STATE ______ ZIP ______________________

*MEMBERSHIP NUMBER _____________

PHONE (_______)__________________________

EMAIL ___________________________________

* Please provide membership number (if known), when renewing an existing membership.  This may be found at the upper right of the mailing label found on regularly received envelopes....Please make checks or money orders out to GM&OHS, and mail this form with appropriate amount to:

GM&OHS Secretary, P.O. Box 1753, Marion, IL  62959