Decatur(IL)Genealogical Society Membership Application New_____ Renewal _____
Membership Year is January 1 - Dec 31
To receive a Membership Card - PLEASE INCLUDE AN SASE (SELF-ADDRESSED, STAMPED ENVELOPE)
Enclose check and mail to: Decatur Genealogical Society P. O. BOX 1548 Decatur IL 62525-1548
Please TYPE or PRINT Legibly

Name ___________________________________________________Phone ______________________

Family Memberships may list a second member ______________________________________________
Additional family members, 18 years or younger may be added for $5.00 per person.

Mailing Address: ______________________________________City___________________

State __________ Zip+4 _________________ E-Mail Address: ______________________________________________

Winter (or other address) ___________________________________ City ___________________

State __________ Zip+4 _______________ Start___________ End __________

MOVING???? Publications will NOTbe returned to DGS with an address correction.
Replacement quarterlies will be sent, if requested, at a charge of $3.00 per issue plus $1.25 postage.

EIGHT (8) SURNAMES OF INTEREST - PLEASE PRINT LEGIBLY IN ALPHABETICAL ORDER
New members Surnames of Interest will be listed in the first quarterly published after their membership has been processed.

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MEMBERSHIP CLASSIFICATIONS
(Out of U.S. please write for cost)  
*Memberships mailed after April 1st - add $5.00 for mailing of back Qtly's & Newsletters

Individuals, libraries or societies $20.00________    Family Membership (2 adults-same household) $30.00________
Additional Memberships for family members age 18 or younger  $5.00____

If you would like your newletter sent electronically please mark here _______ and enter your e-mail address above

Donations to these funds are appreciated. Monies contributed to a specific fund will only be used for that fund.

Operating Expense $_________ Bld Maintenance $__________ Lib Holdings $___________ Lib Equipment $___________

___________________MEMBERSHIP STAFF USE____________________
Cash/Check #____________________ Date_________________ $________________ SASE________________

Donation__________________ Date Processed _________________S/N   S/R   F/N   F/R  

Batch ______________ Initials ____________