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Instructions:
Please print this blank form on your printer,
fill it in with a pen, and mail it along with your
check or money order for $15.00.
Mail to:
Illinois State Poetry Society
744 So. Kensington Ave.
LaGrange IL 60525
Please make check or money order payable to:
Illinois State Poetry Society
We would welcome a short bio (optional) along with your membership form
to help other members become acquainted with you.
This bio would be printed in our member newsletter but would not be posted on the Web without your prior permission.
Please check one:  New Member Renewal
Members are welcome to attend and participate in multiple chapters but must select the chapter in which they will vote on ISPS or chapter business.
Voting Chapter (select one):
Founding Chapter (west Suburban)
North Suburban Chapter
At Large Chapter
Name: ____________________________________________
Address: _________________________________________
City, State, Zip: ____________________________________
Telephone: (H)_________________ (W)_________________
E-Mail Address: ______________________________________
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The above information will be kept confidential within the ISPS and will not be published on the Web.
Questions?
E-mail John J. Gordon at
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