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_________________________________________________ (Circle one) Street Address ___________________________________________________ City _______________________________ State ______ Zip _______ - _____ Home (Evening) Phone ( _____ ) ________________ Work (Day) Phone ( _____ ) ________________ New ________ Renewal _______ Email Address ______________________________ |
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TYPE OF MEMBERSHIP: _____ Regular - US$25 per year (Publications are sent Bulk Mail) _____ Family - US$30 per year (For 2 persons at same address) _____ Contributing - US$35 per year (Publications are sent 1st Class) _____ Foreign - US$40 per year (Publications sent are Airmail) _____ Supporting - US$50 per year _____ Sustaining - US$100 per year FOR OFFICE USE ONLY: Date _________________ Expires ___________ Amount ______________ Check # ___________ Please mail with your payment in US Funds to: Immigrant Genealogical Society P. O. Box 7369 Burbank, CA 91510-7369, U.S.A. |