MEMBERSHIP FORM
 
  Select a membership:  
  Name:  
  Home Address:  
  City: State: Zip:
  Phone: Fax:
  Home County: Home E-Mail:
  Cell Phone(optional)
     
  Employer:  
  Position: Grade Level:  
  School/Office :  
  School Address:  
  City: State: Zip:
       
  Work Phone: Work Fax:  
  Work County: Work E-Mail:  
 
Our membership list may be given or sold to groups; check this box if you want your name excluded.
 
   
  We urge you to make an additional DONATION to assist in our committee work. IAGC is a
not-for-profit organization and your donation is tax deductible to the extent the law allows.		  
 
The cost for a year individual membership is $50.
 
 
 
Donation:
$__________

Fill out the form, print and SEND
it, along with your CHECK to:

IAGC MEMBERSHIP
800 E. Northwest Highway,
Suite 610
Palatine, Il. 60074

 
 
Annual Dues:
$__________
  
 
Total
$__________