MEMBERSHIP APPLICATION

Membership Year is January 1 - Dec 31
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 received.

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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	$15.00	____
Family Membership(2 adults-same household)	$20.00	____
Additional Memberships for family members age 18 or younger	$5.00	____

LIFE MEMBERSHIPS

Individual Life Membership	$300.00	____
Family Life Membership(2 adults-same household)	$500.00	____