Lake County Genealogical
Society
184 Phelps Street
Painesville, Ohio 44077-3927
LCGSOhio@juno.com
Membership Application Form
Dues cover January 1 through December 31 of
the current year.
Amount enclosed: 10.00 US$ for Individual Membership, or
15.00 US$ for a Couple living at the same address.
PLEASE PRINT
Name ______________________________________ (Maiden Name ________________)
Address _________________________________________________________________
City _____________________________________
County ___________________________________
State __________________________ Zip __________ + Four ___________
E-mail Address _________________________________ Phone ___________________
| Member Ohio Genealogical Society | YES ____ | NO ____ |
| Member First Families of Ohio | YES ____ | NO ____ |
| Member First Families of Lake County | YES ____ | NO ____ |
Researching Lake County Surnames; Approximate Years;
Township(s)
_____________________________________ ___________ ____________________
_____________________________________ ___________ ____________________
_____________________________________ ___________ ____________________
_____________________________________ ___________ ____________________
If you want a membership card, please enclose a SASE or pick it up at a membership meeting.
Form last updated 2 OCTOBER 2006