Membership Application

Print this document, complete and mail to

Carroll County Genealogy Club

P. O. Box 395

Hillsville, Virginia 24343

Name: ___________________________________________________

Address: _________________________________________________

City, State, Zip: ___________________________________________

Telephone: _______________________________________________

E-mail: __________________________________________________

Membership Type: Individual ($15)_____________ Family ($18)___________

Donation $______________ Building Fund Contribution $_______________

Researching the families of: ___________________________________________

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Need Information on: __________________________________________________________

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