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LIFE MEMBERSHIP APPLICATION You may print this page for your application form.Name(s):__________________________________________________________________________ Address:__________________________________________________________________________ City:______________________________________ State:______________ Zip:_____________ OPTIONAL (Phone:_________________________ Email:__________________________________) Check membership grade desired. Family Membership is offered to two or more persons
residing at the same address. The age of the oldest member of the family determines
the fee for FAMILY LIFE MEMBERSHIP. Please provide proof of age. A copy of any official document which
shows the members birth date will suffice. | |||
| LIFE MEMBERSHIP: | Age 70 & up | Individual $125 ___ | Family $175 ___ |
| Age 60 to 69 | Individual $175 ___ | Family $225 ___ | |
| Age 50 to 59 | Individual $225 ___ | Family $275 ___ | |
| Age 40 to 49 | Individual $275 ___ | Family $325 ___ | |
| Age under 40 | Individual $325 ___ | Family $375 ___ | |
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Include a check or money order, payable to OGSGS, for the selected membership fee. Mail the completed application to: EXECUTIVE SECRETARY Signature:__________________________________________________ Date:___________________ Please let us know what Orangeburgh surnames you are researching: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ | |||
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20apr2012
