Membership Application for the Virginia-North Carolina Piedmont Genealogical Society
Serving the counties of Franklin, Henry, Pittsylvania and Halifax in Virginia and Rockingham, Caswell and Person in North Carolina
Please print the form below on your printer, fill in the blanks and mail it to the Society at the address given below.
[Please cut along dotted line] [Please cut along dotted line]
-------------------------------------------------------------------------------------------------------------------------
MEMBERSHIP APPLICATION
VA-NC PIEDMONT GENEALOGICAL SOCIETY, P.O. Box 2272, Danville, VA 24541-0272
Date of Application __________________________________ For Calendar Year _____________
Name: ___________________________________ Street _______________________________
City: ____________________________________ State: ___________ ZIP: _______________
E-Mail: ____________________________ (Entering address gives permission to publish)
Surnames Researching: (Limit five) Locality and Dates (46 spaces only, DO NOT REPEAT if same as last year)
|___________________________||______________________________________________________|
|___________________________||______________________________________________________|
|___________________________||______________________________________________________|
|___________________________||______________________________________________________|
|___________________________||______________________________________________________|
Membership is $15.00 and is for a calendar year (January through December). Piedmont Lineages is published quarterly. Please make checks payable to the VA-NC Piedmont Genealogical Society.
Received by: _______ Date: ______________ Check No. ______ Cash: ______ Mbr. No. _______
-------------------------------------------------------------------------------------------------------------------------
[Please cut along dotted line] [Please cut along dotted line]