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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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:
Charter $12 [Charter plus any amount of family members in same house = $15]
Senior (65+) $15 [Senior plus any amount of family members in same house = $20]
Individual $20 [Individual plus any amount of family members in same house = $25]
Sponsor $50 [no extra charge for family members]
Donor >$50 [no extra charge for family members]


All membership levels include four quarterlies and reduced copier fees. Sponsor and Donor level memberships also get their name listed in the Quarterly. Donors will also get their name added to a plaque. Membership runs from January 1 to December 31.

Renewing Members should pay by March 31st to keep in good standing.
New Members receive the Quarterlies that have been issued for that year at the time they join and will be sent any remaining to be issued.

Membership cards will be sent upon request.

 

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 (made out to PCHGS) to the above address.

 


Sample image of new donor and memorial gift plaque.


 

 

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Copyright Piatt County Historical and Genealogical Society: 2007 to 2013

This page last revised: December 2013