“Shop Local First” Application

Select Membership Type:

Business member - $100.00 per year
Community Group or Sustaining member - $50.00 per year
Individual or Friend member $25.00 or in - kind services $
One-time Contribution - $ per year


Business Facts:

Paid by

Cash $ Check # Please send an invoice

We are recruiting local retail stores, businesses, companies, individual citizens and other civic organizations to become Members of "Shop Local First".

Make checks payable to “Shop Local First”

send this form and check to
Shop Local First
PO Box 154
Carlinville, Illinois 62626-0154

OR call Jan @ 217/854 - 8162 for this to be picked up personally