| Personal Information: Please Print Clearly |
Name: |
Spouse's Name (only for joint membership) |
Address: |
City: State: Zip: Phone #: |
E-mail Address: |
Surnames: Include as may as you want, continue on back!
Release of Information
Permission is given for this data to be placed on the OCGS website as well as for any/all Society activities, except for those noted below: __________________________________________________________ Signature ________________________________________________ Spouses Signature________________________________________ Todays Date______________
Annual membership category
____$15 Single-one vote ____$15 Couple-one vote ____$5 Students with ID, through Graduate School-one vote ____free Seniors 90 years of age and over-one vote ____$150 Life time membership-one vote
Make check payable to:
Orleans County Genealogical Society
P.O. Box 103
Albion, NY 14411