GENEALOGICAL SOCIETY OF ROCKINGHAM & STOKES
COUNTIES, NORTH CAROLINA

MEMBERSHIP  
(     )NEW  (     )RENEWAL

____ INDIVIDUAL  ($20)
____FAMILY         ($25)
____STUDENT     ($10)
                                   ____PATRON(Any amount over Normal Dues)
       ____INSTITUTIONAL  ($10)
____LIFE  ($300
)


NAME(S):_________________________________________________

ADDRESS:________________________________________________
        
_________________________________________________

PHONE #:________________________(    )HOME  (    )CELL

EMAIL ADDRESS:___________________________________________
(      )SAME   (      )THIS IS NEW/DIFFERENT

FAMILIES:_________________________________________________

JUST PRINT THIS PAGE AND
PLEASE MAKE CHECKS PAYABLE TO GSRS & MAIL TO  
GENEALOGICAL SOCIETY OF ROCKINGHAM & STOKES NC
RE: MEMBERSHIP DUES
P.O. BOX 152
MAYODAN, NC 27027