Online Interactive Membership Application — Chicagoland Daylily Society

Chicagoland Daylily Society
Membership Application

PLEASE COMPLETE AND PRINT THIS FORM BEFORE CLICKING ON “SUBMIT”

Mail form and check payable to Chicagoland Daylily Society Membership Secretary

Margaret Colucci, 6319 Fairmont Ave, Downers Grove IL 60516

Name

First Name

Last Name

Home Phone

(###)

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####

Cell Phone

(###)

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Checkbox

Option 1 $15 a year (one person at address)

Option 2 $20 a year (two persons at same address)

Photo Release

I grant Chicagoland Daylily Society the permission to disclose my identity and to reproduce and distribute digital images, photographs, transparencies, videotapes, films and sound recordings that are acquired during documenting Chicagoland Daylily Society programs. The signer may revoke this permission at any time in writing to the Chicagoland Daylily Society.