Membership Application
                                
            Rock Island County Illinois Genealogical Society
              

Name _________________________________________________________

Address ______________________________________________________

City/State ________________________________  Zip______________  
                                                 (nine-digits)
Area Code/Telephone (______) _____ _________

E-Mail _______________________________________________________  
  
  Check one:

____ Regular Membership.............................................. $ 20.00
____ Family Membership............................................... $ 22.00
     (Add $2.00 for each member over two)
____ Charter Membership.............................................. $ 12.00
____ Student Membership.............................................. $ 10.00
____ Contributing Membership......................................... $ 40.00
____ Life Membership................................................. $300.00
  Plus you may also make a donation to:
____ Stern NARA Gift Fund Donation .................................. $      .  
     ===============================================
TOTAL ............................................................... $      .
Is this a new membership?  Y ____  N ____

Membership year is from January 1 to January 1. You will be receiving a
membership card.

In order to receive your quarterlies, we MUST have your entire nine-digit zip code
as it is now required for bulk mailing by the U.S. Postal Service. Current
international postage will be billed if appropriate.

Please notify us of your change of address as soon as possible! 
                                
Remit by check payable to:  Rock Island County Illinois Genealogical Society
                            P.O. Box 3912
                            Rock Island Illinois 61204-3912