MEMBERSHIP APPLICATION
PUTNAM COUNTY GENEALOGIAL SOCIETY
P.O. BOX 403 OTTAWA, OH 45875-0403
e-mail: putnamgenealogy@yahoo.com
website: putnamgenealogy.com

____ NEW ____ RENEWAL ____ INDIVIDUAL ($10.oo) ____ JOINT ($12.00) __ LIFE MEMBERSHIP

For the year starting Jan 1, 2009 and ending December 31, 2009

Name – Last ____________________  First ______________________

Address __________________________________________________

City _____________________ State ____________ Zip Code _________

Phone No. ________________ Email ____________________________

Surnames being researched _____________________________________

Make checks payable to: Putnam County Genealogical Society

For office use only: Cash __________ Check No. _________ Date: ________ Deposited Date ___________