MEMBERSHIP APPLICATION

BRADLEY COUNTY

GENEALOGICAL SOCIETY

P. O. BOX 837

WARREN, ARKANSAS 71671-0837

(Please Print)

Name: ____________________________________________________________

Address: ____________________________________________________________

City: _______________________ State: ___________ Zip: ____________

E-Mail Address: ______________________________________________________

Phone Number: ______________________________________________________

MEMBERSHIP: (Memberships begin January and end December of each calendar year)

Individual $18.00 Family $20.00

Surnames of which you are interested in Bradley County:

1. _________________________________ 6. _________________________________

2. _________________________________ 7. _________________________________

3. _________________________________ 8. _________________________________

4. _________________________________ 9. _________________________________

5. _________________________________ 10. ________________________________

[BCGS USE ONLY]

Date Rec’d: ______________________________

Amount: ______________________________