Oregon Genealogical Society

Membership Form

Call for more information or mail this membership form with your check or money order to:

O.G.S., P.O. Box 10306, Eugene, Oregon 97440-2306; (541) 345-0399

_____ $30 US yr. Individual Membership

_____ $40 US yr. Family/Household (two persons)

_____ $60 US yr. Contributing (Individual/family)

_____ $120 US yr. Sustaining (Individual/family)

_____ $500 US Lifetime Individual Membership

New _____ Renewal _____ Check Number_____

Membership is for the calendar year January 1 through December 31. Add $8 US per year for membership outside of the U.S.A. Membership cards may be picked up at the OGS Library. If you wish your card mailed, please enclose a stamped, self-addressed envelope.

Amount enclosed $________________

NAME_______________________________________________________________

SPOUSE______________________________________________________________

MAIDEN NAME_______________________________________________________

ADDRESS____________________________________________________________

CITY/STATE/ZIP_______________________________________________________

TELEPHONE___________________________________

E-MAIL ADDRESS______________________________________________________

OGS MEMBER NUMBER_____________ SPOUSE MEMBER NUMBER_____________

If you are a new member, please provide the following additional information for a friend or relative not living with you:

NAME________________________________________________________________

ADDRESS_____________________________________________________________

CITY/STATE/ZIP________________________________________________________

TELEPHONE___________________________________

YOUR DRIVER'S LICENSE NUMBER______________ STATE OF ISSUE_____________

SURNAMES YOU ARE RESEARCHING:

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

By signing this membership form, I hereby give my permission to OGS to distribute my name, address and pedigree chart information for publication. I agree to follow the rules of the Oregon Genealogical Society, Inc., to pay all costs and/or service charges for materials lost, damaged, or returned late, and to accept all legal responsibility for OGS materials borrowed.

Signature______________________________________________________________

Date______________________________

I do not want to join at present, but I do want to support the Oregon Genealogical Society. Enclosed is my tax-deductible contribution of $____________