| Bronzeville Historical Society |
| 773 291-9115 |
Membership Form
BRONZEVILLE / BLACK CHICAGOAN HISTORICAL
SOCIETY MEMBERSHIP APPLICATION
Name of Individual
or organization:
Your home or mailing
address:
City/State / Zip
Organization /Site Address
City State ______Zip Tel:
Cell phone: Web site:
E-mail address:
Proposed organizational representative to
Bronzeville Historical Society
Representative’s title, street address, telephone, fax and e-
mail address if different than above:
Type of membership : Individual ($18.00)
Family ($21.00)
Contributing ($30.00) Life Member ($250.00)
Corporate Sponsor /
Legacy Membership
($10,000.00 or more)
DATE____________________ Membership Year:
Complete this application and return by e-mail
make payment by electronic funds to:
Express Donation
OR MAKE CHECK PAYABLE TO
BRONZEVILLE HISTORICAL SOCIETY
SEND BY U.S. MAILS TO:
P.O. BOX 53345
CHICAGO, IL 60653-0345
[email protected]
773 291-9115
www.BronzevilleHistoricalSociety.com
BRONZEVILLE / BLACK CHICAGOAN HISTORICAL
SOCIETY MEMBERSHIP APPLICATION
Name of Individual
or organization:
Your home or mailing
address:
City/State / Zip
Organization /Site Address
City State ______Zip Tel:
Cell phone: Web site:
E-mail address:
Proposed organizational representative to
Bronzeville Historical Society
Representative’s title, street address, telephone, fax and e-
mail address if different than above:
Type of membership : Individual ($18.00)
Family ($21.00)
Contributing ($30.00) Life Member ($250.00)
Corporate Sponsor /
Legacy Membership
($10,000.00 or more)
DATE____________________ Membership Year:
Complete this application and return by e-mail
make payment by electronic funds to:
Express Donation
OR MAKE CHECK PAYABLE TO
BRONZEVILLE HISTORICAL SOCIETY
SEND BY U.S. MAILS TO:
P.O. BOX 53345
CHICAGO, IL 60653-0345
[email protected]
773 291-9115
www.BronzevilleHistoricalSociety.com
