Received from:
Name:
Address:
City, State, Zip:
Telephone:
email (optional):
  • Annual member dues are for the period of time from one annual member's meeting until the next (currently the first Thursday evening in April).
  • Your membership dues must be paid in order to vote at the annual meeting.
  • The treasurer can receive your dues on the night of the meeting, before the meeting begins.
  • Lifetime members (denoted with * below) have their names engraved upon a plaque in the museum.
In payment of: Amount:
Annual dues for one individual - $12.00  
Annual dues for husband and wife - $25.00  
Lifetime membership for an individual - $150* (specify engraving such as Jennifer D. Andrew)  
Lifetime membership for family - $250.00 * (specify engraving such as Laurie and Michael Dolan & Family)  
Donation to be used for:  

Mail your check, payable to H.M.C.A., Inc., and this completed form to:

H.M.C.A., Inc.
38757 N. US Highway 45
Old Mill Creek, IL 60046

Thank you for your continued support!

for office use
treasurer secretary mailing list plaque