Membership Application Please print and complete this application with the following information and mail it with your check for dues (payable to The Brevard Genealogical Society, Inc.) to: The Brevard Genealogical Society, Inc. P.O. Box 1123 Cocoa, FL 32923-1123 Annual membership dues are $20.00 per person and $25.00 per couple. Dues are payable in December and effective for one calendar year. A member is considered delinquent if the dues are not paid by the February meeting of the new year. Name: ____________________ Spouse's Name: ________________________ Address: ________________________________________________________ City: ____________________________  State: ______  Zip: _______________ Home Phone: ______________ E-mail: _______________________________ Summer Address (if applicable):________________________________________ Summer Phone:_________ Use summer address from ________ through __________ I understand that my name, address, phone and email address will be printed in the Brevard Genealogical Society Annual Membership list which is available to members. Email addresses will be used for the private Society Announcement List.   I can subscribe or unsubscribe from the public list at: https://mailinglists.rootsweb.com/listindexes/legacy/other/Genealogical_Societies/FL-BREVARD-GENSOC.html Signed X _________________________________________ Date: ____________ Spouse X ________________________________________  Date: ____________ Where did you hear about us?______________________________________________________ Form BGS-2 (Rev. 5/05)

Original material Copyright © 1999-2005 Brevard Genealogical Society, Inc

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