Enclosed is my check for $20.00 for my/our Membership:
(Or $______________ for __________ years Membership) *Maximum 5 Years

Enclosed is my check for $15.00 for my/our Membership, and my Descendant or   
 Ancestor
Chart(s). I hereby grant the Genealogy Society of White County, Illinois to publish
 this/these chart(s).

Enclosed is my Donation in the amount of $____________ to help the Society get
started.




Name:___________________________________________________________

Address / PO Box:_________________________________________________

City, State, Zip:____________________________________________________

Phone:____________________________________________________________

Email:____________________________________________________________


The Surname(s) I am researching are:

___________________________________________________________________

___________________________________________________________________

*Please submit queries on a paper*

I am willing to help the Society out by:

____________________________________________________________________

Make checks payable to:

Genealogy Society of White Co. IL

P.O. Box 142

Carmi, IL 62821-0142