ONE YEAR MEMBERSHIP APPLICATION

NAME ________________________________________________________

STREET ________________________________________________________________

CITY _________________________________________________________

STATE ________________ ZIP ________________

EMAIL ADDRESS ________________________________________________________________

PHONE _______________________________________

$10.00 single ____________ $20.00 family _____________

$30.00 Organization/Business __________

Print page & mail along with your check payable to:
Shawnee Trail Conservancy
P.O. Box 44
Eddyville, IL 62928


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