Membership Application

Name

Address
City
State
ZIP
    $10 - Associate or Gift
    $15 - Friend of Maeystown
    $25 - Contributor
    $100 - Patron
    $250 - Life

Complete this form, print it, enclose a check for the amount selected above made payable to Maeystown Preservation Society and mail to:

    Maeystown Preservation Society
    PO Box 25
    Maeystown, IL 62256