JOIN NOW! - Phone 1-800-87-ABATE for more info

------------------------------------- fill out the form, print it out and mail it in ----------------------------------- 

A.B.A.T.E. OF ILLINOIS MEMBERSHIP APPLICATION/RENEWAL FORM

New Member (1) (2) Renewal (1)(2) Membership# (1) (2) Date

Original Date Joined (if renewal) (1) (2) Chapter Preference

Name (1) (2)
Address City
 State Zip County Phone  

Congressional Dist. Senatorial Dist. Representative Dist. Registered Voter (1) (2) 

Date of Birth (1) (2) Occupation (1) (2)

Completed a MSF Course (1) (2) Where did you hear about ABATE?

AMOUNT $ Check Enclosed  Visa  MasterCard  Discover     Expiration Date:

CARD NUMBER: Signature:___________________________________  
(Credit Card Registrations can be faxed to A.B.A.T.E. @ 309-343-6387)

MEMBERSHIP & RENEWAL FEES: $25.00 PER YEAR SINGLE    $45.00 PER YEAR COUPLE
MONEY-SAVER SPECIAL: $100.00 - 5 YEARS/SINGLE    $180.00 - 5 YEARS/COUPLE
ABATE-PAC SUPPORT: Add $1.00 per year to dues amount to support legislative contributions.

*** $2 of each members dues is allocated to lobbying expense. ***

MAKE CHECK PAYABLE & MAIL TO: 
A.B.A.T.E. OF ILLINOIS, Inc. - c/o Northwest Suburban Chapter
PO Box 441, Arlington Heights, IL  60005-0441

MUST BE 18 TO JOIN  -  (309) 949-3443 or  800-87-ABATE   -  FAX (309) 343-6387

I understand that ABATE of Illinois cannot assume responsibility for my safety and that if I participate in any sanctioned event, I so so voluntarily, assuming all risk; I release and hold ABATE harmless for any injury or loss to my personal property which may result therefore. I understand this means that I agree not to sue ABATE for any injury resulting to myself or my property at any event. I agree to comply with the Bylaws and act in the best interest of A.B.A.T.E. of Illinois, Inc. A copy of ABATE-PAC's report is or will be filed with the State Board of Elections, Springfield, Illinois.

Signature(s) (1)___________________________________  (2)___________________________________