South Shore Genealogical Society
P.O. Box 901, Lunenburg, Nova Scotia
CANADA B0J 2C0
Name: _______________________________________ Applying__ or Renewing __
Address: _____________________________________
City/town: _____________________________________
Province / State:________________________________
Country: ______________________________________
Postal / Zip Code: ______________________________
Phone Number: ________________________________
Email: _______________________________________
Research Lines: (only 3 names for publication) _______________________________________________________________
_________________________________________________________________
_________________________________________________________________
Include Research Lines in Directory? __Yes or __No
Dues for the Year
Individual ___ $15.00
Family ___ $20.00
Junior ___ $ 3.00
Donations $ ______
Memorial Donations $ ______ in memory of: ___________________________________________
For office use only: Date received: Enclosed $ ______ Receipt number: