MEMBERSHIP APPLICATION

Genealogical Society of Douglas County Oregon Douglas County Courthouse, Room 111 1036 SE Douglas, Roseburg OR 97470 541-440-6178 ~ gsdc@co.douglas.or.us
 Name  Phone
 Address
 City/State/Zip:
 E-mail: (print clearly)
 New  Renewal Reinstate Life

Membership is from January 1 to December 31

___ Enclosed is $15 for 6 issues of the GSDC Newsletter only. ($20 for family)

___ Enclosed is $15 for 4 issues of the Douglas County Pioneer only. ($20 for family)

___ Enclosed is $20 for BOTH GSDC Newsletter & Douglas County Pioneer. ($25 for family) 

___ Enclosed is $25 for Individual Contributing Membership. ($30 for family) Includes GSDC Newsletter & Douglas County Pioneer. This membership is designated for future goals.

___ Enclosed is $225 for LIFE membership which includes Newsletter &/or Douglas County Pioneer.

~ PLEASE MAKE CHECKS PAYABLE TO GSDC ~

If returning by mail, please enclose an SASE if you want a membership card.

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This space is for GSDC staff, please do not fill in below!
 Check Amount:  Check #  Cash Amount:  Date:
       
 DCP: 1 2 3 4

 GSDC NL: 1 2 3 4 5 6