Text Box: CIHS membership form (please print)


Name(s)__________________________________________________________


Address___________________________________________________________


City_________________________________ State_________ ZIP____________


Phone_________________  email ______________________________________

Dues are $10/year:  qnew  qrenewal   	amount enclosed ______________
Make check to CIHS; mail check and form to: CIHS, P.O. Box 3098, Peoria, IL 61612-3098