P.0. BOX 1419
GUTHRIE, OK 73044-1419
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Today's date:______________ New member _________________Renewal: _____________________
(prorated after July 1)(Due by March 1)
Enclosed is my check for:
____ Membership Fee (Jan.1-Dec. 31)
$20/year per Individual or
$20 + $5 per each add'l family member
____ Tax-deductable Gift (optional)
____ Total Enclosed
NAME________________________________________________________________________________________________
ADDRESS_____________________________________________________________________________________________
(Street or P0 box) City State ZIP
PHONE_______________________________________________________________________________________________
E-MAIL:_______________________________________________________________________________________________
WEB PAGE ADDRESS:________________________________________________________________________________
SURNAMES I AM RESEARCHING:
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Please indicate if any of the surnames have LOGAN COUNTY, OKLAHOMA, connections:
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May we include these names on our web page on the INTERNET? ______ In the LCGS News? _______
QUERY: ____________________________________________________________________________________________
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