Name:______________________________________________________
Address:____________________________________________________
City, State Zipcode:___________________________________________
Home Phone:________________________________________________
Work Phone.:________________________________________________
Email:______________________________________________________
Please check one: New Member _____ Renewal _____
Comments:_________________________________________________
How did you hear about the ISEA ? _______________________________
Membership Types and Annual Dues
The ISEA offers these types of memberships (please circle your choice and fill in the Total Due):
| Student | $ 20 |
| Senior | $ 20 |
| Individual | $ 30 |
| Family | $ 40 |
| Business | $ 100 |
| Premier Business | $ 250 |
| Charter Business | $ 500 |
| Lifetime Individual | $ 500 |
| Additional Donation | $ __________ |
| Total Due | $ __________ (tax deductible) |
Please make your check payable to "ISEA" and postal mail it
with this membership application form to:
ISEA
800 W Evergreen Ave
Chicago, IL 60622
Attn: Membership