| Membership Category: Date:_____________
Individual ($20)__________ Family ($25)__________
Life ($150)__________ Family Life ($200)__________
Would you like to make a donation to the Library Fund (purchase of books, CDs, etc). If so, please add your donation to your membership fee.
Full Name(s): ___________________________________________________________________
(Include full names of both members if this is a family membership)
Badge(s): ___________________________________________________________________
(How do you want your name(s) to appear on your badge(s); if female, be sure to provide your maiden name
Street Address: ___________________________________________________________________
Apt/Unit No.: __________________
City/State/Zip (+4): _________________________________________________________________
Telephone (with area code): (______) ______ -___________
E-Mail: ___________________________________
If you move North any time during the year, please provide:
Date of Departure: __________________ Date of Return: _________________
Street Address: ___________________________________________________________________
Apt/Unit No.: __________________
City/State/Zip (+4): _________________________________________________________________
Telephone (with area code): (______) ______ -___________
E-Mail (if different from above): _____________________________
| My genealogical interests are: | Learning more about my family_____________
Joining a lineage society____________________
Sharing with others____________________ |
URL - if you have a website:____________________________________________________________
Please print, fill out (even if your contact information has not changed),
make check or money order payable to:
Martin County Genealogical Society, Inc., and mail to:
Treasurer
Martin County Genealogical Society, Inc.
P.O. Box 275
Stuart, FL 34995-0275
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