ESGR APPLICATION PAGE

ERIE SOCIETY FOR GENEALOGICAL RESEARCH (ESGR)

P. O. Box 1403
Erie, PA 16512-1403

APPLICATION FOR MEMBERSHIP

Full Name of Applicant: _______________________________________________________________

Address: __________________________________________ Phone No: ______/________________

City/State: _________________________________________ 9-Digit Zip Code: __________________

E-Mail Address: ___________________________________________

THE FOLLOWING WOULD BE APPRECIATED:
Occupation (past or present):

Organizations in which you hold membership (patriotic, historical, genealogical, heraldic, civic, etc.:

TYPE OF MEMBERSHIP REQUESTED:
____ Individual $15.00 ____*Family $21.00 _____ Lifetime $300.00

*Family consists of two persons (one individual and one associate) in the same household;
only one mailing of our quarterly bulletins, "Keystone Kuzzins", will be received, four times a year.
I would like to volunteer to help the ESGR in the following way:

____ research ____Reading Room ____proofreading ____ telephoning

____ typing ____computer input ____filing ____ other _______________

Add my name/address/phone # to our List to give to other members? ____Yes ____No

I AGREE to aid the work of the Society, to abide by its ByLaws, and to protect and preserve all things genealogically and historically. Copies of the ESGR ByLaws are available at the ESGR office or may be requested by calling (814) 454-1813, ext. 29.

(1)__________________________________ Signature (2) __________________________________ Associate Signature

MAIL APPLICATION AND CHECK TO: Erie Society for Genealogical Research, P. O. Box 1403, Erie, PA 16512-1403

Date Received Fees: ______________________ Date Card Sent: _______________________

Membership Number: ______________________ Surname Forms Mailed: _____ Received:______

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