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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