Moultrie County Historical & Genealogical Society
Membership Application

Name______________________________________________Telephone__________________

Address______________________________________________________________________

City_______________________________________State___________Zip Code____________

Surnames Research_____________________________________________________________

Membership Dues
Year ______

 

Charter $12.00 Check___       Cash___
Regular $15.00 Check___   Cash___
Student $2.00 Check___   Cash___
Sponsoring $25.00 Check___   Cash___
Sustaining $100.00 Check___   Cash___

Please remit by cash or by check made payable to MCH&GS and forward to teh Society at Post Office Box 588, Sullivan, IL  61951-0588.  Include postate (SASE) for mailing your membership card or pick it up at the Heritage Center, 117 E. Harrison, Sullivan, IL

Membership Dues are due January 1st of each year.

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