CENTRAL
CALIFORNIA CHAPTER-AHSGR
MEMBERSHIP AND RENEWAL FORM FOR 2007
Membership fees are for calendar year that renew each January 1st.
Membership Categories - Annual International and Central California Chapter Dues:
| Central California Chapter $15.00 ___ | International Dues $50.00 ___* |
| Contributing $75.00 ___ | Int'l Life Member-Chapter Dues $15.00 ___ |
| Institutional $50.00 ___ | Student (15-24 yrs) $15.00 ___** |
| Sustaining $100.00 ___ | Youth (1-14 yrs) $8.00 ___** |
| Int'l Life Member $1050.00 ___ (40 years old & younger) January 1, 2007*** |
| Int'l Life Member $900.00 ___ 41 years to 55 years old) January 1, 2007*** |
| Int'l Life Member $750.00 ___ 56 years
& over) January 1, 2007***
|
| *ONLY
NEW International AHSGR Member's $50.00 dues will be prorated quarterly. (Jan-Mar=$50.00, Apr-Jun=$37.50. Jul-Sep=$25.00, Oct-Dec=$12.50) ___ ** See Junior Membership Application *** May be paid in 5 annual installments |
SEND BOTH INTERNATIONAL AND CHAPTER DUES TO THE LOCAL FRESNO CHAPTER
MAKE
PAYABLE TO: CENTRAL CALIFORNIA CHAPTER-AHSGR
3233
N. West Ave, Fresno, CA 93705-3402
PLEASE HELP US BY FILLING IN THE FORM COMPLETELY
If you have any questions, contact the library - (559) 229-8287
-------------------------------------------------Fill in blanks only when applicable---------------------------------------
Surname:
____________________________________________H-Birth-date ____/______/________
(Last Name first, First Name last, please) (yr. optional)
Spouse's Name
________________(((_______________)))
W-Birth-date ______/_____/________
(If Applicable) (First name)
(Woman's maiden name) Wedding Date
_________/_____/________
Address
:____________________________________________ City/ State:
______________________
9 digit ZIP:
________-______ Telephone: (
) ____________________
Email:
_______________________________________________Occupation ______________________
Husband's
Ancestral Wife's Ancestral
Village(s): ___________________________________Village(s): ________________________________
LIST ALL
SURNAMES YOU ARE RESEARCHING: ___________________________________________
___________________________________________________________________________________
I
would like my Central Calif. Chapter's monthly Newsletter delivered by Email
(Adobe Acrobat Format) Yes__
Also, the CDC Report (Adobe Acrobat Format)
Yes__
Additional Information For Headquarters in Lincoln, NE:
Please
designate your Primary Chapter affiliation.
If other than Central California: 1.____________________
Life Member in which chapter? 2.____________________
New Member Referred by: ____________________________________
Office
Staff only:
(MemApp)
Date Paid
________Amt. Paid ______Year paid for ______Renewal __New __ Catg: _____
PR__CpR__
Dues Rem__ ML__ SML__ CpEM __PEm__ CDC__Cpb/l__Pb/l __New MemPak__***NL__