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    Black Genealogy Search Group Membership Application

     NAME (first, last & middle): _________________________________________
     ADDRESS: ___________________________________________ APT: _______
     CITY/STATE/ZIP: _________________________________________________

     TELEPHONE: ___________________   E-MAIL: _________________________

                __ Member Renewal  __ New Member  __ Newsletter Only

           Surnames         State            County                   City/Township

    _______________   _____   __________________   ____________________

    _______________   _____   __________________   ____________________

    _______________   _____   __________________   ____________________

    _______________   _____   __________________   ____________________

Annual Memberships:  are $20.00 per year (renewable every January)
   and Includes four (4) quarterly newsletters.

   Household (Family) Memberships:
are $30.00 per year.

    Newsletter Only Subscriptions:
are $10.00 per year for four issues.

    Please make checks payable to: The Black Genealogy Search Group

   Mail to BGSG, P.O. Box 7276 Denver,CO 80207   

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