AMERICAN HISTORICAL SOCIETY of GERMANS FROM RUSSIA
NORTHERN ILLINOIS CHAPTER

AHSGR Membership Application ______ (year)
Covers the year from January 1st through December 31st


Name:________________________________________________________________________


Spouse Name:_________________________________________________________________

Address:_____________________________________________________________________

City/State/Zip:______________________________________________________________

Phone:_____________________________ E-Mail: _________________________________

Birth Month (you)____________(spouse)_____________

Ancestral Village(s):________________________________________________________

Surname(s):__________________________________________________________________ 

Make checks payable to Northern IL AHSGR and mail to: 
Membership: Maggie Hein
5902 W. Midway Park
Chicago, IL. 60644

Or pay in person at a chapter meeting - we'd love to meet you.

________$7 Northern Illinois Chapter dues (per person)
________$14. Northern Illinois Chapter dues (for two)
________$50. for AHSGR International dues (per person)
________$ TOTAL
________Check here if you paid dues directly to AHSGR in Lincoln, NE

We will accept both Chapter and International Dues!!