Genealogical Society of Sarasota Membership Application


OFFICE USE ONLY
  in database ________   Date_______________________   member card ______

MEMBERSHIP APPLICATION
  (  ) NEW MEMBER - Please Fill Out Entire Form. 
  (  ) RENEWAL   - Name, Check/Cash Amount, Address, Phone and EMail
  (  ) RENEWAL  CHANGE/S - Address/es, phone number, E-mail, etc. 

PLEASE PRINT			

Mr/Dr_____________________________________ ____________________________________
                       Surname                       Given Name

Mrs/Miss/Ms/Dr_____________________________ ___________________________________
                       Surname   	                 Given Name                             
     
Local Address______________________________________________________


City/State___________________________________Zip___________Phone_______________


E-mail address _________________________________________________


Seasonal Address ______________________________________________


City/State___________________________________Zip___________Phone_______________
 
          From Dates_________________  To____________________

ANNUAL DUES:
 $15.00 a year per person, $30.00 per family, July 1 through June 30.
                Half rates for Jan. 1 thru June 30.
 $ 5.00 a year. Student membership (Elementary, secondary & college).
 $45.00 a year. Sustaining membership, two members same family.
 $50.00 a year. Supporting membership, two members same family.

Payment: Please circle amount enclosed. Check #_______Date_________Cash________

Make check payable to GENEALOGY SOCIETY OF SARASOTA, INC. and bring it with this completed form to the next meeting or mail both to     

                                    Genealogical Society of Sarasota, Inc.
                                    PO Box 1917
                                    Sarasota, FL  34230-1917

Your membership card will be given to you at the next meeting or will be mailed to you if you provide a SELF-ADDRESSED, STAMPED ENVELOPE.


Do  you wish to have your name, address, phone number and e-mail listed in our annual Membership Directory?     Yes       No


I want to Volunteer for: ____Programs    ____Publicity   ____SIGs

____Selby volunteer ____Membership  ____Newsletter    ________________Other