IDW Membership Application

 Name: ___________________________________________________

 Address: _________________________________________________

 City: ____________________________   Zip: ____________________

 County: __________________________________________________

 Email: ____________________________________________________

 Phone: _________________ Alternate Phone: _________________

 Annual Dues:        

$20 ________	$50 _________	$100 + _________
Individual	Sponsor	Patron

 

A copy of our report is(or will be) filed and available for purchase
from the State Board of Elections, Springield, IL.

Make checks payable Illinois Democratic Women and mail to: Illinois Democratic Women Membership Chair Susan Wood 3518 Sheridan Springfield, IL 62703