Spouse:_______________________________________ (Maiden Surname:_______________)

Street:______________________________________________________________________

City, State:____________________________________________

9-Digit Zip Code (Zip + 4):________________________________

Phone: Area Code: _________ Number:_____________________

E-Mail Address: ________________________________________

Type of Membership:

Unless you request otherwise, the above information (excluding maiden name) will be included in the next Roster update to be mailed to members only. This information will not be distributed to libraries or other organizations.

How do you wish to receive your newsletter? ____email ____regular mail

Are you a member of OGS? ____Yes ____No


Signature:__________________________________ Date:_________________

On a separate page, please list any surnames that you would like to be posted on our web page. Please use the following format:

Surname / Time Period / Area (County/State/Country)