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Northland Genealogy Society
MEMBERSHIP APPLICATION AND RENEWAL FORM

Individual Membership - $15.00 Family Membership - $25.00

Make your check payable to the Northland Genealogy Society.
Mail to:
P.O. Box 14121
Parkville, MO 64152
Memberships are renewable on January 1.

Name__________________________________________________________

Telephone Number _______________________

E-Mail Address ____________________________________________

Address________________________________________________________

City ________________________________________________

State ____________          Zip Code __________________

SURNAME INDEX
Please list surnames that you are researching.
Surnames                  Areas/States                 Countries
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