Please print out this form, fill it out and return it, with your check, to:
Attn: Membership Chair
P.O.Box 115
Paxton, IL 60957-0115
Annual dues are payable September 1st of each year.
Please mark the desired level of membership
| ____ History Teacher -- Honorary Membership | $ Honorary |
| ____ BASIC Individual, _____ persons, $10.00 each for individuals under the age of 85 | $__________ |
| ____ LIFE Membership (in one payment) _____ persons, $100.00 each in single lump sum or in four $25 annual installments |
$__________ |
| ___"May I give EXTRA to help with postage?" Yes, and Thank You! | $__________ |
| Make your check payable to F.C.H.S. …………………………TOTAL | $__________ |
My name: _________________________________________________________________
My spouse (at same address): _________________________________________________
Street Address: ____________________________________________________________
City, State & Zip code: _______________________________________________________
Phone: ____________________________ E-mail Address: _________________________
Gift Memberships are always a great idea!
Fill out the above information with the recipient of the gift in the address area, circle “Gift Membership” above and add your name below. The recipient will receive a membership card along with a notice of your gift. For multiple gifts send one check along with a form for each gift membership.
Gift from: _________________________________________________________