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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 BEINGRESEARCHED (maximum 6)each spelling variation counts as one name

Choose one:NewRenewal

Choose one type of membership (multiple-year memberships are not available at this time):
$20 Individual, Libraries, Societies One-year Membership (begins July 1, 2005 and expires 30 June 2006)
$30 Contributing One-year Membership (begins July 1, 2005 and expires 30 June 2006)
$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 RcvdMember#
Amt RcvdExpiration
Check#Entered
This page was updated 04/20/05.
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2002-2005 Chicago Genealogical Society