CCHS Online Membership Form

CCHS Online Membership Form

Memberships in the CCHS support ongoing programs and efforts, and ensure that the museum is open to the public without an entry fee. The membership year runs with the fiscal year of January 1 to December 1 of each calendar year.
Condition Statement:

Thank you for your interest in the Champaign County Historical Society.

Payment can be made using any major credit card or debit card. Transactions are processed via Square and are encrypted for your protection.

Be sure that your browser (particularly Google) is up to date. An email will be sent to you immediately from noreply@jotform.com. Your purchase is complete as soon as you see a Thank You post with a green check mark.

CCHS Refund Policy: Refunds for credit card purchases must be requested either via email to champaigncohistory@gmail.com or regular mail, and will be calculated as the (price of the item) less (associated credit card processing fees). Credit card reimbursements will only be made directly to the credit card used for the original transaction.

Use of this form constitutes agreement.
Member Name*

First NameMiddle NameLast NameSuffix
Additional names to associate with this membership:
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Are you renewing your membership today?*

Yes!No, I'm a new member!Yes, but change my/our membership level!No, this is a gift membership
Is this a gift membership?

YesNo
Can we publish your donation per CCHS publicity protocols?*

YesNo, keep my membership private

Choose your Membership Level, and add any additional donation into the Additional Donation item.

Designate my membership donation toward the following:

Unrestricted - use how it's most neededArchival exhibition casesTextile storageEducational supportAcquisitions/care of collectionsOther
Other: Please designate as...
I'd like to volunteer!

Docent/school tour guideOffice helpCommitteeExhibit design/fabricationSpecial events/set up for eventsOther
Other volunteer opportunities I'd like to help with...
Should be Empty:

CCHS Online Membership Form

Credit Card