COVINGTON COUNTY

GENEALOGICAL AND HISTORICAL SOCIETY

Annual Membership Application

Membership in the Society is from November 1st to October 31st of each year. We offer three membership types.  Please indicate your choice:

 Individual ~ $15.00 per year
 Family (couple) ~ $20.00 per year
 Lifetime: ages 0-90 ~ $50.00
 Lifetime: ages 90+ ~ Free

Name _______________________________________________

Address _____________________________________________

City, State, Zip _______________________________________

E-mail Address _______________________________________

Covington County Surnames you are researching:

____________________________________________________

____________________________________________________

Please complete this form and mail with your check or money order to:

        CCGHS

        PO Box 381
            Collins, MS 39428