MEMBERSHIP APPLICATION_____ RENEWAL FORM _______ 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.
(Out of U.S. please write for cost)
*Memberships mailed after April 1st - add $5.00 for mailing of back Qtly's & Newsletters
PLEASE CHECK APPROPRIATE LINE BELOW
Individuals, libraries or societies
Family Membership(2 adults-same household)
Additional Memberships for family members age 18 or younger