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. (Rev. 10/2026)
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
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Are you renewing your membership today?
Is this a gift membership?
Can we publish your donation per CCHS publicity protocols?

Individual Membership - New

$25.00

Individual Membership - Renewal

$20.00

Family Membership - New

2 Adults and 2 Children

$50.00

Family Membership - Renewal

2 Adults and 2 Children

$40.00

Sponsor

$100.00

Benefactor

$250.00

Patron

$500.00

Additional Donation

Enter the amount of your donation in the Donation box.

$1.00 Quantity
Item subtotal:

Send me hard copy newsletters

$5.00

Enter coupon

Total

Credit Card

Apple Pay

Google Pay

ACH Bank Transfer