Calumet Heritage Partnership Annual Membership Form

Registration Form
Name _________________________________
Organization __________________________
Address _______________________________
City/State____________ Zip Code _________
Phone _________________________________
E-mail ________________________________

Annual Dues:
Individual Sustaining $ 20.00
Individual $ 10.00
Senior Citizen / Student $ 5.00
Non-Profit Organization $ 25.00
Corporate/Government $ 50.00

Total Amount Enclosed  $_______

Make check/ money order payable to the
CALUMET HERITAGE PARTNERSHIP

Please send registration form and payment to the
Calumet Heritage Partnership
13300 S. Baltimore Avenue
Chicago, Illinois 60633