Membership application

LGS Membership Application

(Please print this page to use for your membership application)

Longmont Genealogical Society Membership Application

Name ____________________________________________________________________

Maiden Name (if applicable) ___________________________________________________

Second Family Member (if applicable) ____________________________________________

Birthday Month__________________________________Day of the Month______________

Address

Street __________________________________________________________________

City/Town _______________________ State___________Zip+4_____________

Telephone: (___) __________________ E-mail: _____________________

Check One:

__ Individual membership ($15.00)

__ Family membership ($18.00)

Mail to:

Longmont Genealogical Society

P.O. Box 6081

Longmont, CO 80501-2077

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updated 12/27/2012