Historic Elsah Foundation
Application For Membership
P. O. Box 117
Elsah, Illinois 62028
Foundation Officers
_______ $25 - $99 Patron
_______ $100 - $249 Supporter
_______ $250 and over Founder's Circle
_______ $100 James Semple Business Associate
Name _______________________________________
Address _______________________________________
City _______________________________________
State _______________________________________
Zip _______________________________________
GIFT MEMBERSHIPS are also available.  To order, please --
  • print the names and addresses of recipient on the reverse side of this sheet;
  • indicate the type(s) of membership(s) you wish to give;
  • indicate if you wish the renewals of these gift memberships sent to you.

All contributions to Historic Elsah Foundation are tax deductible.
Your support is deeply appreciated.  

Date:______________________________

(To members of the Principia community:  You may send your membership, I-O, to Cathy Barlow, Treasurer)

(Print out membership form, cut off here for your records)

Membership in Historic Elsah Foundation

Check#_______________Amount $________________Date Sent__________________

Gift Memberships_______________________________