Full Page View of Membership Application for Printing

Membership Sign Up Form

Yes! Please Enroll me/us
as member(s) of the
Edgewater Historical Society.
Enclosed are my/our dues.
Individual*.........$10.00
Family*.............$15.00
Patron..............$50.00
Student (under18)....$1.00
Senior Citizen.......$5.00
Business (minimum)..$50.00
(*Fee assistance available upon request)
Yes! I/we support the
Edgewater Historical Society
Museum at 5358 N. Ashland Ave.
Enclosed is a donation.
Chief........$5,000 or more
Captian......$1,000 - $4,999
Brass Pole.....$500 -   $999
Brigade........$100 -   $499
Hose Crew.......$50 -    $99
Dalmation.......$
Please check the appropriate category
Enter your Name(s)
Enter your Address here
City, State, Zip
Phone number
Enter your E-Mail address here
I am interested in finding out more about the following Committee(s)
Fundraising
Collections
Finance
Membership
Program
Bd.Development
Historical Sites
Property
Communications
Make checks payable to :
Edgewater Historical Society
Please mail completed for and your check to:
Jim Anderson
Edgewater Historical Society
1718 West Gregory
Chicago, IL 60640
Contact: 773.907.1872 for furthur information
All contributions are tax-deductable to the extent allowable by law.
Thank you for your support.

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