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MEMBERSHIP APPLICATION

Membership Year is January 1 - Dec 31
To receive a Membership Card - PLEASE INCLUDE AN SASE (SELF-ADDRESSED, STAMPED ENVELOPE).
Enclose check and mail to:Decatur Genealogical Society P. O. BOX 1548 Decatur IL 62525-1548
Please TYPE or PRINT Legibly

Name ___________________________________________________Phone ______________________

Family Memberships may list a second member ______________________________________________
Additional family members, 18 years or younger may be added for $5.00 per person.

Mailing Address: _______________________________________________________________________

City_____________________________ State __________________ Zip+4 ________________________

E-Mail Address: _________________________________________________________________________

Winter (or other address) _______________________________________________________________

City __________________________State ______________ Zip+4 _________________________________

Date alternate address to start? _______________ Date to end? ________________________

MOVING???? Publications will NOT be returned to DGS with an address correction.
Replacement quarterlies will be sent, if requested, at a charge of $3.00 per issue plus $1.25 postage.

EIGHT (8) SURNAMES OF INTEREST - PLEASE PRINT LEGIBLY IN ALPHABETICAL ORDER
New members Surnames of Interest will be listed in the first quarterly published after their membership has been processed.

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MEMBERSHIP CLASSIFICATIONS
(Out of U.S. please write for cost)  

*Memberships mailed after April 1st - add $3.00 for mailing of back Qtly's & Newsletters

PLEASE CHECK APPROPRIATE LINE BELOW


Individuals, libraries or societies
$20.00____


Family Membership(2 adults-same household)
$30.00____


Additional Memberships for family members age 18 or younger
  $5.00____