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4626 N Knox Ave • Chicago IL 60630 • 773/282-7035 • Fax 773/282-0380 • Email

Membership Application Form
Please complete all information,
print this page, and send it with your check.
ON-LINE FILING IS NOT YET AVAILABLE. OUR HOST SERVER IS NOT SECURED FOR TAKING YOUR CREDIT CARD SAFELY.
This will change in 2007.
FOR NOW, PLEASE PRINT FORM AND MAIL IT.

Which level of membership interests you?

Application Status

New Membership Renewal Inquiry only

First Name Last Name

Spouse's Name

Street Address

City State Zip

Country (outside of U.S.)

Phone

E-mail (required)

The IAHC is an Illinois non-profit organization, registered with the Internal Revenue Service to receive tax-deductible contributions to the extent allowable under law.

Membership includes minor-children under age 18.

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