(Check one) _____ Annual Member _____ Family Member _____Life Member
(Check one) _____ New Member _____ Renewal _____ Convert Annual to Life Member
(Circle one) Mr. Mrs. Dr. Ms. Other___________
Name:____________________________________________________________________
Address:__________________________________________________________________
City, State/Province, Zip:_____________________________________________________
Country:___________________________________________________________________
Telephone:_________________________________________________________________
Email:_____________________________________________________________________
Webpage:__________________________________________________________________
Winter or alternate address:___________________________________________________
For Family Membership please list spouse and children under 18 ___________________________________________________________________________
___________________________________________________________________________
Earliest Known Ancestor: _________________ Date: ______ Location: ________________
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