Name_______________________________________Date_______________________

Mailing Address_________________________________________________________

Residence______________________________________________________________

City, State, Zip+4________________________________________________________

Telephone - [Home]______________________________________________________

E-mail address__________________________________________________________

[ ] Please send me monthly meeting notices. [Enclose an additional $2.50 for meeting notices.]

Areas of special interest and/or expertise:

__________________________________________________________________________

Families [maternal & paternal] presently being researched:

__________________________________________________________________________

Type of Membership:
[ ] Student - Free (18 or younger - no newsletter)

[ ] Individual - $12.00 - [ ] New [ ] Renewal

[ ] Joint - $15.00 (two individuals in one household) - [ ] New [ ] Renewal

[ ] Organization - $25.00 - [ ] New [ ] Renewal

[ ] Sustaining - $50.00 - [ ] New [ ] Renewal

[ ] Supporting - $100.00 - [ ] New [ ] Renewal

[ ] Donation - $_______________________

Make checks payable to MCHAGAI. Mail your check and membership application to Morgan County History And Genealogy Association, Attention: Memberships, P. O. Box 1012, Martinsville, IN 46151-0012.

15 February 2003