IDW Membership
Application
Name: ___________________________________________________
Address: _________________________________________________
City: ____________________________ Zip: ____________________
County: __________________________________________________
Email: ____________________________________________________
Phone: _________________ Alternate Phone: _________________
Annual
Dues:
| $20 ________ |
$50 _________ |
$100 + _________ |
| Individual |
Sponsor |
Patron |
A copy of our report is(or will be) filed and
available for purchase
from
the State Board of Elections, Springield, IL.
|