North Eastern Illinois Historical Council (N.E.IL)
www.neilhistoricalcouncil.org
Membership Renewal - 2016
Please PRINT:
Full Name of Organization _____________________________________________________________
Address ____________________________________________________________________________
City____________________________________________
Phone Number________________________________
Zip Code._______________________
FAX_____________________________
E-Mail _______________________________ Web Site ______________________________________
Email is preferred form of communication. Mailing via USPO available for those not using email.
N. E. IL Delegate:______________________________________________________________________
E-Mail_________________________________________
Phone:_________________________
OR USPO mail: Address ________________________________________________________________
Alternate Delegate:_____________________________________________________________________
E-Mail________________________ ________________________
Phone______________________
OR USPO mail: Address_________________________________________________________________
Submitted by:_________________________________________(name/title)
Date__________________
Please mail completed form, along with check payable to North Eastern Illinois Historical Council to:
Beverly Dawson, Membership Chair
700 Woodmere Lane
Glenview, IL 60025
Annual Dues: January 1-December 31, 2016
____$35 - Museums/Societies/Groups
____$20 - Associate/Individual (non-voting)