Piatt County Historical and Genealogical Society

1115 N. State Street, Suite 119

Monticello Illinois 61856

Open - Monday and Wednesday 1:00 - 4:00 P.M.
Extended hours on the first two Mondays of each month 1:00 - 8:00 P.M.
Except Holidays

Or By Appointment

Phone: 217-762-9997

E-Mail: piatthistory@gmail.com

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We've moved and we have extended hours!
Come visit us at our new location!

Application for Membership

Required Information

New Member: ______ Renewing Member: ______

Date: _____________________

Name: __________________________________________________________________

Address: ________________________________________________________________

City: ___________________________________ State: ________ Zip: _____________

Permission given to list my name and information in the newsletter? Yes ______ No _______

Optional Information

E-Mail: ____________________________________ Phone: ______________________

Surnames Searching: _______________________________________________________

Dues: $15.00 for individuals; additional family members are $2 each.

Membership includes four quarterlies. Membership runs from January 1 to December 31.

Gift memberships are always a great idea! If you have a friend or family member who is interested in history or genealogy, give them a membership as a gift. We will send them a notice and membership card.

(Print this form, fill it out and mail it along with your check to the above address.)

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This page last revised: February 2013