Peoria Area Illini Club Membership Form

Membership Form

Fill out the following information to join PAIC or renew your $25 Premium Membership
MEMBER INFORMATION:
Full Name*
Street Address*
City*
Zip Code*
Phone Number*
Email Address*
School at Illinois (BUS, ENG, LAS, etc.)
Graduation Year
Committee

I am interested in serving on a PAIC committee
Payment Method*
All payments are securely routed through Paypal. You will be redirected to Paypal's online portal to enter payment details. It is not necessary to have a Paypal account in order to pay your PAIC membership fee online.
Credit Card Payment
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PAIC Annual Membership$25.00

Total $0.00
Check Payment

PAIC Annual Membership $25.00
Please make your check payable to "Peoria Area Illini Club" and mail to:

Peoria Area Illini Club
401 Main Street, Suite 1600
Peoria, IL 61602
Should be Empty: