Morgan County History and Genealogy Association

MEMBERSHIP APPLICATION

Name_______________________________________Date_______________________

Mailing Address_________________________________________________________

Residence______________________________________________________________

City, State_________________________________________Zip+4________________

Telephone______________________________________________________________

E-mail address__________________________________________________________

Areas of special interest and/or expertise:

__________________________________________________________________________

Families presently being researched:

__________________________________________________________________________

Type of Membership:       [ ] New    [ ] Renewal

All memberships are for the current calendar year

[ ] Please send me monthly meeting notices. [Enclose an additional $2.50 for meeting notices.]

[ ] Student - Free (18 or younger - no newsletter)

[ ] Individual - $12.00 -

[ ] Joint - $15.00 (two individuals in one household) - [ ] New [ ] Renewal

[ ] Organization - $25.00 - [ ] New [ ] Renewal

[ ] Sustaining - $50.00 - [ ] New [ ] Renewal

[ ] Supporting - $100.00 - [ ] New [ ] Renewal

[ ] Donation - $_______________________ (Receipt will be provided upon request).

Mail check to MCHAGAI, P. O. Box 1012, Martinsville, IN 46151-0012

        Thank you for your support.

                                                                                                                                                                                                                                              Dec 2014