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Send completed Form and Fees to:


Scott County Genealogical Society, Inc.


P. O. Box 23
Scottsburg, Indiana 47170-0023


Membership Form

Membership fees are:
One year Single Membership...........$12.00_____
One Year Husband and Wife............$15.00_____
Student Membership (K-12)............$5.00_____
Lifetime Single Membership...........$120.00_____
Lifetime Husband and Wife.............$150.00_____

As a member, you may use the Research Rooms at no charge.
Members receive four newsletters a year, queries free.
Membership is from January 1st to December 31st.

Name____________________________Date______________________
Address____________________________________________________
City______________________________State__________Zip_________
Phone(____)_______________________E-Mail____________________

Surnames you research_________________________________________
___________________________________________________________
___________________________________________________________

Query______________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________

(Make check or money order payable to: Scott County Genealogical Society, Inc.)

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