Membership Form
Yes, I want to be a member of the Jefferson County Historical Society and help preserve the Heritage of Jefferson County!
Enclosed is my check for $ ____
Please circle membership category.
| Youth | $9 | Contributor | $50-99 |
| Individual | $18 | Benefactor | $100-299 |
| Couple | $25 | Corporate | $300 & up |
Name______________________________________________________ Date_________
Mailing_Address_________________________________________________________
City_____________________________________ State_____________ Zip________
Telephone___________________
Mail this form with your check to:
| Jefferson County Historical Society |
| 1411 N 27th St. |
| Mt Vernon, IL 62864 |