| Personal Information: Please Print Clearly |
| Name: |
| Spouse's Name (only for joint membership) |
| Address: |
|
City: State: Zip: Phone #: |
| E-mail Address: |
Surnames: Include as many 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 forany/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