APPLICATION FOR MEMBERSHIP OR RENEWAL

             (Annual Membership from 1 Jan to 31 Dec)


Date _________________________

$15 single member ____________                 New member ____________

$20 joint members (same address) ____________     Renewal ____________

Check for change of address:  ________  

NAME _________________________________________________________________

ADDRESS ______________________________________________________________

CITY __________________________ STATE _________________ ZIP __________

PHONE (    ) ______________   EMAIL __________________________________

SURNAMES _____________________________________________________________

         _____________________________________________________________

         _____________________________________________________________

Make check or money order payable to:

Old Dobbs County Genealogical Society
P.O. Box 617
Goldsboro, NC  27533-0617

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