PO
Application for Membership
Dues are paid on a Calendar
year basis. Dues received after 31 October are credited with dues paid for the
following year. Please check one of the following categories:
Principal membership: $25.00
Dual
membership: $ 5.00
Student:
$10.00
Life
(Principal) membership: $260.00
Life
(Dual): $65.00
Memorial (Does not include
Newsletters or Quarterly issues):
$25.00 - In memory of _________________________________
New
Member Renewing Member Previous Member Memorial Member or Gift Membership
Title (Mr/Mrs/Ms/Dr):
__________ First Name: _______________ Nickname: ______________
Middle/Maiden Name (Enclose
maiden name in parentheses): ____________________________
Last Name:
_________________________________________________________________ _____
Dual Member (First,Middle,Last Name): ______________________________________________
Address: _________________________________________________________________
_______
City:
Telephone (Home):
(_____)_____-________________ (Work): (_____)_____-________________
Birthday (Princ): ________________________
Birthday (Dual): ________________________
Wedding Anniversary:
____________________ E-mail Address: __________________________
Surname Search:
_________________________________________________________________
State/Country Search: _____________________________________________________________
Please mail this application,
along with your payment, to: Jacksonville Genealogical Society, Inc., PO Box
60756, Jacksonville, FL 32236-0756
Do
not write below this line - For Official Use
Date Paid: ___/___/20___ Amount Paid: $______ Type: _______ ID: _______ Year 1st Joined: _____