Coles County Illinois Genealogical Society Miss Mr. Mrs.____________________________________________________________________________________________ First Middle Maiden Last Family Member__________________________________________________________________________________________ First Middle Maiden Last Address_________________________________________________________________________________________ City____________________________________________________________________________________________ County__________________________________________________________________________________________ State____________________ Zip__________________+4_________ Email Address:__________________________________________________________________________________ Surnames of interest in Coles County:___________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ Other data of interest:_________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ Please check one:
Membership Application (Please print a copy of this form) (Please Print or Type)
( ) Individual Membership............................................................$16.00 ( ) Family Membership (2 persons - same address)......................................18.00 ( ) Patron Membership.................................................................25.00 Membership for current year open through December 31. Please list surnames of interest in Coles County if you are using this as a renewal form. Please make checks payable to: Coles County Genealogical Society P.O. Box 592 Charleston, IL 61920-0592