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Name: _____________________________________________________ Address: ___________________________________________________ City: ___________________________County: ___________________ State: ___________________________Zip: _______________________ Email Address: ______________________________________________ Phone Number: _____________________________________________ Date: ______________________________________ Are you new to genealogy? Yes No Are you currently member of other genealogy societies? Yes No
If yes, which
ones____________________________________________ Special talents/skills/resources________________________________ _____________________________________________________________ Annual Dues (Circle One): $15.00 Individual $25.00 Family
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