MEMBERSHIP APPLICATION

Date ____________________
Name: ___________________________________________________
Address:
Address: _________________________________________________
               _________________________________________________
Telephone
Telephone #:_______________________________________________
E-mail:___________________________
DUES: Individual - $12.00 Family $15.00
MAIL TO: 319 W. Center Avenue, Sebring, FL 33870


Would you be willing to HELP?
Please check all the projects or committees on which you would be willing to work:
_____ Publicity           _____ Library                 _____ Publications    
_____ Programs          _____ Cemetery               _____ Fund-Raising
_____ Obituary          _____ Membership             _____ County Records
_____ Entertainment     _____ Pioneer Certificates     _____ Workshops & Seminars


PERSONAL INTEREST:
PERSONAL INTEREST: To help the Society serve you better, please fill in the following:
Surnames of interest to you, County, State or Country where they were located, and time periods:

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