Manito Historical Society

               New Membership Form 2011

Name:__________________________________________________________________

Address:________________________________________________________________

City:____________________________________St:_____________ Zip:____________

Phone:___________________________ Alternate Phone:_________________________

Email:__________________________________________________________________

_____Annual Dues: $5.00                                 _____Lifetime Membership $100.00

Additional donation: $__________  The Historical Society has participated in many projects  since Manito’s Sesquicentennial and is planning a restoration project for the Old  Jail.  Any extra donations would be welcomed.  Please send this form and dues to:

Jim Wistehuff

810 E. Southmoor Street

Manito, IL 61546