BGS MEMBERSHIP FORM

MAIL MEMBERSHIP FORM WITH PAYMENT PAYABLE TO:

 

Burlington Genealogical Society
Post Office Box 593
Burlington, WI. 53105-0593

 

(Please Print)

DATE: ______________

NAME : __________________________________________|___________________

  (Last, First Middle) | (Maiden name)

ADDRESS: ___________________________________________________________

CITY________________________________STATE______ZIP_________________

TELEPHONE: (____)_____ ___________ NEW [_] RENEWAL [_]

OTHER GENEALOGICAL SOCIETIES TO WHICH YOU BELONG, IF ANY:

_____________________________________________________________________

AREAS OF YOUR INTEREST (COUNTRIES OR STATES. OR RESEARCH YOU WOULD
LIKE TO KNOW MORE ABOUT):

______________________________________________________________________

______________________________________________________________________

SURNAMES BEING RESEARCHED:

_________________________________, ___________________________________

_________________________________, ___________________________________

E-MAIL ADDRESS_____________ HOME PAGE URL __________________________

YEARLY MEMBERSHIP DUES:  $15.00