LINC INC.

Membership Form

Fill out all information requested, print and mail this form along with your check or money order in the membership level amount to:

LINC, Inc.
Attn: Anita Overturf
120 East A Street
Belleville, IL 62220

Name

Address

City State    Zip

Home Phone Work Phone

Email Address

Membership Level (Check Appropriate Box)

$10 Individual Membership (Consumers & Volunteers)
$20 Individual Membership
 $35 Family/Not-For Profit Organization

$50 Business Membership
$100 Investor Membership

Donations above membership amounts are always appreciated.  Amount:_______________