Fellows Membership to the Illinois Bar Foundation Your membership in the Fellows makes it possible for the Illinois Bar Foundation to support and improve the justice system thoughout the State of Illinois. Name: ______________________________________________________________ (please print) Address: ___________________________________________________________ City: ______________________________________________________________ State: _______________________ Zip: _______________________________ Birthdate: _________________________________________________________ ____Fellow $1,000 or $100/year* ____Silver Fellow $2,000 or $200/year* ____Gold Fellow $5,000 or $500/year* ____Diamond Fellow $10,000 or $1,000/year* ____Pillar of Profession $15,000 or $1,500/year* ____Pillar of Foundation $25,000 or $2,500/year* * Pledges may be payable over ten years My check, made payable to the Illinois Bar Foundation for, $__________________ is enclosed. Please charge my VISA/MasterCard $__________________ Acct. No: ________________________________________________________ Exp. Date: _______________________________________________________ Signature: _______________________________________________________ Please complete this form and return to: Illinois Bar Foundation 424 South Second St. Springfield, Illinois 62701