Membership Form

 

Membership's Application

PIKE COUNTY  GENEALOGY & HISTORICAL SOCIETY

P. O. Box 224, Waverly, Ohio 45690-0224

Membership for:    2018______2019______2020_______2021________  2022_______ 2023 _____________

(check one or more)

Please print or type:

NAME: ________________________________________________________________________________________

ADDRESS:_______________________________________________________________________________

__________________________(please include 4+zip)

PHONE:(   )_______________________  FAX:(   )______________________________

E-MAIL:______________________________________________

Dues:

_________$  10.00  Single Member                      _________ Renewal

_________$ 12.00  Family Membership                  _______ New Member

(Members will receive four newsletters of Pike County information per year.)

(Dues are due January 1st of each year)

Please send your 5 generation charts, 3" x 5" ancestor cards,

copies of your Bible Records and articles about your Family.

SURNAMES BEING RESEARCHED:____________________________________________________________

___________________________________________________________________________________________

Optional:

I hereby give the Pike Co. Genealogical & Historical Society permission to use in the publications and/or newsletters the following:

YES ___    NO ___   5 GENERATION CHARTS

YES ___    NO ___   BIBLE RECORDS

YES ___    NO ___   CORRESPONDING LETTERS

YES ___     NO ___   PHONE NUMBERS    YES ___    NO ___   

YES ___    NO ___   ADDRESSES      YES ___     NO ___   E-MAIL ____

SIGNATURE:_______________________________________  DATE_________________________

PLEASE PRINT OUT THIS APPLICATION, FILL IN THE APPROPRIATE

SPACES, AND MAIL BOTH THE COMPLETED APPLICATION AND YOUR

REMITTANCE TO:  P. O. Box 224, Waverly, Ohio 45690-0224

Please support the society & keep it in operation!

image43