P.O. Box 346 Kewanee, Illinois 61443
Organized January24, 1983

MEMBERSHIP FORM

Memberships are from Jan 1-Dec 31, 20____

NAME:____________________________________________________

STREET:__________________________________________________

CITY:_____________________STATE:__________ ZIP:____________

PHONE: ______________________ e-mail: ______________________

__Individual Life Membership_______________________$ 150.00
__Family Life Membership_________________________ $ 175.00

__Charter Individual Renewal (joined during 1983)_______ $ 12.00
__Charter Family Renewal (joined during 1983)__________$ 13.00

NEW____Individual $ 20.00___ Family $ 20.00___ RENEWAL__ DONATION_______

Surnames of interest in Henry County__________________________________________________________

THANK YOU FOR YOUR SUPPORT

Mail completed form along with your check to:

Henry County Genealogical Society
P.O. Box 346
Kewanee, Illinois 61443

 


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