Summer Beginning Genealogy Course Registration
and

Membership Application

Please print and complete this application with the following information and bring it to a meeting or mail it with your check for $20.00 (payable to The Brevard Genealogical Society, Inc.) to:

The Brevard Genealogical Society, Inc.
P.O. Box 1123
Cocoa, FL 32923-1123

Course fee includes membership dues in The Brevard Genealogical Society from the starting date of the course through December 31 of the calendar year. If you are already a paid member of BGS please deduct $8.00 from the course fee.

Name: __________________________________________ Spouse's Name: ___________________________

Address: ________________________________________________________________________________

City: ___________________________________________ State:____________ Zip:____________________

Home Phone: ___________________ E-mail: ____________________________________________________

Summer Address (if applicable):_______________________________________________________________

Summer Phone:_________________________ Use summer address from ____________ through ____________

I understand that my name, address, phone and email address will be printed in the Brevard Genealogical Society Annual Membership list which is available to members. Email addresses will be used for the private Society Announcement List. I can subscribe or unsubscribe from the public list at:         http://lists.rootsweb.com/index/other/Genealogical_Societies/FL-BREVARD-GENSOC.html

Signed _____________________________________________________________ Date: _______________

Where did you hear about the course? ___________________________________________________________

Welcome to BGS!

Form BGS-4 (Rev. 5/05)