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PARADISE GENEALOGICAL SOCIETY
MEMBERSHIP APPLICATION

Membership fees effective 1/01/2005, through 12/31/2006

To apply for membership in the Paradise Genealogical Society, please print the following form, complete it, and mail with your remittance to the address shown below.

For additional information contact: Jack de Coup-Crank, Membership Chair.

Please click BACK on the TOOL BAR to return when finished.

Please note that monies submitted must be in US funds. 

 
        Please cut off here and mail with your check (no cash please)
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             PARADISE GENEALOGICAL SOCIETY MEMBERSHIP APPLICATION

             PLEASE PRINT                           CHECK ONE
                                         STUDENT (up to age 20)..... $15 ____
NAME____________________________________                            
                                         INDIVIDUAL/INSTITUTIONS....  30 ____
SPOUSE (if appl)________________________ 
                                         FAMILY (same residence)..... 35 ____
ADDRESS_________________________________ 
                                         GOLD MINER (Ind or Fam)..... 50 ____
CITY____________________________________ 
                                         GOLD MINER PLUS (Ind or Fam) 75 ____
STATE___________________________________ 
                                          LIFE (indiv. 50 or over)... 350 ____  
9-DIGIT ZIP CODE________________________                              
                                         (add Spouse to Life Member) 100 ____ 
TELEPHONE ______________________________              
                                         ADDITIONAL DONATION.... $___________
E-MAIL/WEBSITE__________________________                                     
                                         TOTAL ENCLOSED (US).... $___________
Make checks payable to:                      
  PARADISE GENEALOGICAL SOCIETY, INC.    [ ] New membership       [ ] Renewal
Mail to:
  P. O. Box 460                          All memberships, except LIFE, are
  Paradise, CA                           for 12 months.  Fees effective
  95967-0460                             through December 31, 2006.

Thank you.