Application for Membership

Plesase Print all information.

Date________________________ New ( ) Renewal ( ) Institution ( )

I hereby apply for membership in the Afro-American Genealogical and Historical Society of Chicago, Inc.

Please make check or money order payable to AAGHSC. The annual membership dues are $20.00

Name____________________________________________________________________________________________

Address___________________________________________________________________________________________

City______________________________________ State_______ Zip Code__________________

Telphone ( )_____________________________ Email________________________________________________________

Please submit your birthday (year not required) for the Fellowship Committee:Month__________ Day________ Year__________

( ) Check here if you do not want to be included in the AAGHSC membership directory.

( ) Check here if you are renewing and the information above is new.

PLEASE PRINT THIS PAGE AND

MAIL TO: AAGHSC

c/o Membership Committee

P. O. Box 37-7651

Chicago, IL 60637