(Please print this form and mail to the address below)
Membership in TIPCOA and dues are for
one year and run from January through December.
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Name: _________________________________________________________________
Address: _______________________________________________________________
City: _________________________________ State: _____ Zip Code: _____________
Telephone: ( _____ ) ___________________________
E-mail: ______________________________________
Renewal ______
New Member ______ Individual
$12 ______ Family $15 ______
May we publish your name, address and your surnames in our membership roster on our webpage.
Newsletter: Yes _______
No _______
Website: Yes _______ No _______
Include Email address?: Yes: _______
No: _______
Include your mailing address on the webpage Yes: _______
No: _______
Please Make Your Check Payable to TIPCOA
and Send It With This Form to:
TIPCOA Secretary
3503 Indianbrook Drive
Lafayette, IN 47909
*Please write TIPCOA MEMBERSHIP on
your envelope.
We have set up a networking webpage for our
members families. If you would like to be
on our page
you may send your ancestors names from Tippecanoe County.
http://www.rootsweb.com/~intcags/Members_ancestors_TIPCOA.htm/
Ancestors first and last name.
The last State or Country they migrated from
What township did they lived in?
The year they settled in Tippecanoe County, Indiana
Is there a biography? Title and page numbers or send a copy.
