BRHS Membership Renewal Form

Please print this form on your printer and mail to address below.
We suggest you fill out the form on your computer, then print it to mail with your check.
 
BRHS Membership Number
Renew next year's membership as:
Regular: One year $30
 (Entitled to one vote, all activities,and all publications during the year.)
Family: One year $30
 (Same as Regular plus all members of family may participate in contests)
Subscription: One year $30
 (For libraries, museums, societies, and other groups who are entitled to all publications but are not allowed to vote in business matters.)
Sustaining: One year - $60 or more*
 *amount above $30 is tax deductible
For members outside of US add: $20.00 Non-US Postage Surcharge
Total enclosed $
Fill out the following only if changed:
Name
Address
City
State
ZIP
Phone Number
E-mail Address

Make check or money order (DO NOT SEND CASH!) payable to: BRHS then mail to:

Burlington Route Historical Society
Membership Renewal Services, Dept. I
P. O. Box 456
La Grange, IL 60525