Membership Form

 

CAMPBELL COUNTY HISTORICAL & GENEALOGICAL SOCIETY GENERAL MEMBERSHIP FORM

NAME: ________________________________________________NEW: ______RENEWAL: ______LIFE:_______

ADDRESS: ___________________________________________________________________________________

CITY: __________________________________________________STATE:__________ZIP: ________________

PHONE #: _____________________E-MAIL ADDRESS: _______________________________________________

IS THIS A CHANGE OF ADDRESS OR PHONE NUMBER? ___ YES ___ NO

CHECK ONE OR BOTH OF THE FOLLOWING OPTIONS (LEAVE BLANK IF NO REMINDER IS NEEDED):

____ I WOULD LIKE A MONTHLY MEETING REMINDER CALL.

____ I WOULD LIKE A MONTHLY MEETING REMINDER VIA E-MAIL

RETURN THIS FORM, WITH YOUR DUES OF $12.00 PER PERSON ($150.00 for LIFE Membership)

TO: CAMPBELL COUNTY HISTORICAL & GENEALOGICAL SOCIETY
8352 EAST MAIN STREET
ALEXANDRIA, KY 41001

 

 

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