Membership's Application
PIKE COUNTY GENEALOGY & HISTORICAL SOCIETY
P. O. Box 224, Waverly, Ohio 45690-0224
Membership for: 2012______2013______2014_______2015________
(check one or more)
Please print or type:
NAME: _________________________________________________
ADDRESS:_______________________________________________
__________________________(please include 4+zip)
PHONE:( )_________________ FAX:( )_________________
E-MAIL:______________________________
Dues:
_________$ 10.00 Single Member _________ Renewal
_________$ 12.00 Family Membership _______ New Member
(Members will receive four newsletters of Pike County information per year.)
(Dues are due January 1st of each year)
Please send your 5 generation charts, 3" x 5" ancestor cards,
copies of your Bible Records and articles about your Family.
SURNAMES BEING RESEARCHED:__________________________________
____________________________________________________________
Optional:
I hereby give the Pike Co. Genealogical & Historical Society permission
to use in the publications and/or newsletters the following:
YES ___ NO ___ 5 GENERATION CHARTS
YES ___ NO ___ BIBLE RECORDS
YES ___ NO ___ CORRESPONDING LETTERS
YES ___ NO ___ PHONE NUMBERS YES ___ NO ___
YES ___ NO ___ ADDRESSES YES ___ NO ___ E-MAIL
SIGNATURE:____________________________ DATE_______________
PLEASE PRINT OUT THIS APPLICATION, FILL IN THE APPROPRIATE
SPACES, AND MAIL BOTH THE COMPLETED APPLICATION AND YOUR
REMITTANCE TO: P.O.Box 224, Waverly, Ohio 45690-0224
Please support the society & keep it in operation!