Membership Form Annual memberships are based on the calendar year beginning on January 1. PLEASE PRINT CLEARLY _________________________________________________________________________________________________________________ FIRST NAME LAST NAME _________________________________________________________________________________________________________________ PERFORMING GROUP (IF APPLICABLE) _________________________________________________________________________________________________________________ ADDRESS _________________________________________________________________________________________________________________ CITY STATE ZIP _________________________________________________________________________________________________________________ E-MAIL ADDRESS _________________________________________________________________________________________________________________ PHONE _________________________________________________________________________________________________________________ OTHER FAMILY MEMBERS MEMBERSHIP TYPE □ $10 for Individual Membership □ $20 for Family Membership □ $50–$199 for Supporting Member □ $200–$399 for Sustaining Member □ $50–$199 for Supporting Artist □ $200–$399 for Sustaining Artist □ New Member □ Renewal TOTAL AMOUNT $__________________ □ CASH □ CHECK NUMBER_____________________ DATE SUBMITTED__________ INITIALS__________ Please make checks payable to Plank Road Folk Music Society. Send the form to: Plank Road Folk Music Society, P.O. Box 176, Downers Grove, IL 60515 I’D LIKE TO VOLUNTEER □ □YES □NO “QUARTER NOTES” We’re going green! We are now e-mailing our quarterly newsletter “Quarter Notes”. If you can not access “Quarter Notes” on-line please check the box and we will mail a black and white version to you. Please add $3.00 to your membership fee to cover paper and postage. FOR MORE INFORMATION CONTACT Bob O’Hanlon - President | 630-325-7764 | [email protected]