WCMIR Membership Form

WCMIR Membership

Please fill in the information below
Membership Type

New Member Membership Renewal
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail *
example@example.com
Phone Number

Membership Options

Membership Dues $50/yr

$ 50.00 Quantity

Donation

$ 25.00 Quantity

Offline Payment Mail your check to WCMIR - PO Box 1392 - Lombard, IL 60148

Free

Total

$ 0.00

Credit Card

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