Membership Form
Membership Categories (check one) Sustaining - $300 Contributing - $100 Family - $50 Individual - $35 First Name(s): Last Name: Address: Phone:
Membership Categories
(check one)
Sustaining - $300
Contributing - $100
Family - $50
Individual - $35
First Name(s):
Last Name:
Address:
Phone:
Make checks payable to:
Dickson Mounds / Illinois State Museum Society
Print and mail this form to:
Dickson Mounds Museum
10956 N. Dickson Mounds Road
Lewistown, IL 61542
