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MEMBERSHIP APPLICATION and RENEWAL FORM

PLEASE PRINT LEGIBLY:
NAME: DATE:
ADDRESS:
CITY: STATE: ZIPCODE +4:
COUNTRY: HOME PHONE:
E-MAIL  ADDRESS (mandatory for foreign memberships):
SURNAMES   BEING  RESEARCHED    (maximum 6)    each spelling variation counts as one name
           
            

Choose one: New Renewal

Choose one type of membership (multiple-year memberships are not available at this time):
$20 Individual, Libraries, Societies One-year Membership (expires 30 June 2005)
$30 Contributing One-year Membership (expires 30 June 2005)
$250 Life Membership
Additional monies (check all that apply):
$10.00 (All countries outside the U.S., including Canada, MUST add this amount for P&H)
$1.00 suggested as a contribution to NARA (National Archives Fund) 
Make check payable in U.S. funds to: CHICAGO GENEALOGICAL SOCIETY
Mail with this form to: Chicago Genealogical Society, P.O. Box 1160, Chicago, IL 60690-1160
Please send separate checks for Publications, Pioneer Certificates, and other services.
 
 
FOR OFFICE USE ONLY
Date Rcvd Member#
Amt Rcvd Expiration
Check# Entered
This page was updated 04/15/04.
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