Membership Application

Name: _______________________________________________________________________________

Spouse (for joint membership): ____________________________________________________________

Street: _______________________________________________________________________________

City: ____________________ State: ___________

Zip + 4: ______________________________ (required)

Phone: (__________) __________________________________

E-Mail: _____________________________________________________________________________

Single Membership - One Year ____ $10.00
Joint Membership - One Year ____ $15.00
Single Membership - Lifetime ____ $150.00
Joint Membership - Lifetime ____ $200.00

Date of application: ___________________

State O.G.S. Member? ____ Yes ____ No

List, in alphabetical order, up to 16 surnames that you are researching. Joint members may list 16 surnames each.
Please indicate to which person the name belongs. Use more paper if necessary.

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Mail to: Stark County Chapter O.G.S.

P. O. Box 9035

Canton, OH 44711-9035