Membership Form

WAUKESHA COUNTY GENEALOGICAL SOCIETY MEMBERSHIP FORM
P.O. BOX 1541, Waukesha, WI 53187-1541

Membership cost is $12/individual or $15/family per year from September 1 to August 31.
Membership will be prorated at $1 per month for joining mid-year.
Cost includes e-mail copies of newsletters.
Members who prefer hard copies mailed must add $5 per year to the membership fee.

Name(s) ____________________________________________________________________

Maiden Name__________________________________________ Date__________________

Address_____________________________________________________________________

City/State___________________________________________________ Zip Code_________

E-Mail Address_________________________________________ Phone_________________

_____New Member        _____Individual ($12)         _____Address or Phone # Change

_____Renewal                 _____Family ($15)    
[Please include a SASE (self-addressed stamped envelope) if you wish to have a receipt.]

Surnames Being Researched – Maximum of 10 (Filling out this section gives the Waukesha County Genealogical Society the right to include these surnames as well as your name, address and phone number in the Society’s surname list which will be shared with other society members and genealogical organizations.) 
_____________________________________________________________________________

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For Office Use Only:
Check No: ________ Check Date: ________

Check Amt: _______ Exp Date: __________