Defiance County Chapter of the Ohio Genealogical Society Membership Form
Please print or type and send with check made payable to DCGS.
Send to: Defiance County Chapter OGS P. O. Box 7006 Defiance, Oh 43512-7006
Membership year is January 1 through December 31, annual $12.00 per person, $15.00 for family. If you need to update your 5 generation charts, please sign and date with permission to publish for the newsletter and to file at Defiance Public Library Ohioana Room.
First Name__________________________________ Last Name___________________________________
Maiden Name ________________________________Spouse name_______________________________
Address______________________________________ City ______________________________State _____ Zip code ___________-____________Phone # (_______) ________-________
E-mail address_____________________________________________________________________
Occupation/Former Occupation (optional) __________________________________Birth date ______________________________________ New Member ___ Renewal ____ Single ___ Family____ Gift ____
(If gift membership, send name and address of person to receive membership card and newsletter on back of this form) Donation to DCGS for $_______________ Specified Intention (please name) _________________________
Member of First Families of Defiance County, Yes ___ No___ OGS Member? Yes___ No___
Your Surnames in Defiance County (please include township and time period if known)
________________________________________________________________________________________________________________________________________________________________________________
What topic(s) would you like to know more about? (Please specify)
________________________________________________________________________________________________________________________________________________________________________________
What services/support would you be willing to help DCGS with? (Check all that apply) Officer/Trustee __ Committee __ Computer data entry __ Transcribing records __ Proof reading __ Meeting Greeter __ Setting up displays __ Indexing __ Telephone/calling __ Fundraising __ Hospitality __ 1st Families __ Centennial Families __ Speaker/Program __ Education/Teaching __ Other Comments __(write on back, please) I do___ do not___ give permission to have my information printed in any handouts, newsletters, or publications.
Office use only: Date Pd. __________Ck. # ________Cash ___Membership #________Card sent_____ updated: April 2008