We invite you to join the Chicago Herpetological Society. Just print this form and fill it out. Return it with your check or money order payable to the Chicago Herpetological Society. Your subscription to the Bulletin will begin with the next monthly issue.
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Name:_____________________________________________________ Address:________________________________________Apt #_____ City:_________________________State__________Zip__________ Phone(________)________-__________________________________ E-mail____________________________________________________ How did you hear about us?________________________________ __________________________________________________________ |
| Mail To | Membership Level | ||
|---|---|---|---|
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Membership Secretary Chicago Herpetological Society 2430 N. Cannon Drive Chicago, IL 60614 |
___Individual | $25.00 | $_____________ |
| ___Family | 28.00 | $_____________ | |
| ___Institutional | $38.00 | $_____________ | |
| ___Sustaining | $50.00 | $_____________ | |
| ___Contributing | $100.00 | $_____________ | |
| ___Corporate | $1000.00 | $_____________ | |
| ___Outside U.S. please add $12.00 postage | $_____________ | ||
| Donations | |||
| ___Unrestricted | $_____________ | ||
| ___CHS Herpetological Grants | $_____________ | ||
| Animal Adoption Program | $_____________ | ||
| Amount Enclosed: | $_____________ | ||
| Please remit in $US drawn on a US bank. | |||