PRINT THE BELOW FORM, FILL OUT, AND MAIL TO THE ADDRESS BELOW TO JOIN:


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			APPLICATION FOR MEMBERSHIP OR RENEWAL

			The Decatur County Historical & Genealogical Society
			P.O. Box 682
			Bainbridge GA 39818-0682


Date:__________________

Enclosed is $___________ for membership dues in the Decatur County Historical & Genealogical Society

for the calendar year _________.

Please check one of the following:


______ Individual membership $15.00



______Joint Husband/Wife       $25.00



Please check here:    _______New Member   Or     _______Renewal


Please type if possible or print very clearly:

Name: _________________________________________________________________

Address: _______________________________________________________________

City:_____________________________________State:_______ Zip:______________

E-mail address:__________________________________________________________

If desired, telephone number:_______________________________________

The following is a list of the family surnames in which I am interested. I understand they will be listed in the "Southern Searchers" and Society Directory.  A copy of the directory will be placed in the library.   They will also be placed on the Decatur County Historical & Genealogical Web Site.

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