ACCESS ILLINOIS OUTDOORS/TWO RIVERS
MEMBERSHIP APPLICATION

To apply for your membership, please completely fill out the application, print it and mail it with your membership fee to the address listed at the bottom of the page.

MEMBER INFORMATION

Applicant's Information:
 
First Name MI Last Name
Address
 
City State Zip
Home Phone   Work Phone
E-mail
Vehicle Make Vehicle Model
Vehicle Year   License Plate 

PREFERENCES

Please check the type of membership preferred, plus rank the activities you wish to pursue (#1 being most desired activity).

$25 annual membership for one person for all outdoor activities.
$50 annual family membership (living in same household).
Checks payable to: Access Illinois Outdoors/Two Rivers

bow hunting deer trail riding bird watching
gun hunting deer fishing nature study
bow hunting turkey camping misc.hunting
gun hunting turkey hiking lodging
bird hunting outdoor photography other interest
quail
pheasant
dove
duck
goose
 
 
How did you hear about AIO?
friend
IDNR
publication
other
 
Please indicate length of time you are offering:
weekly lease
season lease
annual lease
 
Please rank 1-4 your county choices:
Adams Brown Calhoun Greene
Jersey Pike Schuyler Scott
 
Limited access counties:
Bureau Carroll Cass Clark Clay Crawford
Cumberland DeWitt Edwards Effingham Fayette Fulton
Gallatin Hamilton Hancock Hardin Jackson Jo Daviess
Johnson Kankakee Lawrence Logan Macoupin Madison
Marshall Mason McDonough Menard Montgomery Morgan
Peoria Pope Randolph Richland St. Clair Saline
Sangamon Stark Union Vermilion Wabash Wayne
White Will Williamson Woodford    

(new counties with fewer landowners)

ADDITIONAL MEMBER(S) INFORMATION

Please list names, addresses and phone numbers of members applying with you. (All persons participating must be a member of Access Illinois Outdoors/Two Rivers).

Name
Address
City State Zip
Home Phone

Name
Address
City State Zip
Home Phone

Name
Address
City State Zip
Home Phone

Please provide a short narrative about yourself. (Years of outdoor experience, memberships in outdoor organizations, references, etc.)

Please mark appropriate box:

Race:
 American Indian/Alaskan Native
 Black or African American
 Native Hawaiian or Pacific
 Islander
 White
 Other
 2 or more races		 Ethnicity:
Hispanic
Latino
Non Latino		 Gender:
Male
Female

Double check to make sure the application is completely filled out, print it, and mail it with your membership fee to:

Access Illinois Outdoors
1301 East Washington
PO Box 87
Pittsfield IL 62363

Phone 217-285-2464 or 1-888-285-2464 

Fax: 217-285-2464

Access Illinois is an equal opportunity provider and employer.