Please print and fill out this form and include it with your check or money order.

Name: ___________________________________

Address: _________________________________

City: __________________ State: ___ Zip: ______

Phone Number: ____________________________

E-mail Address: ____________________________

Surnames you are researching: __________________________________________________

I am enclosing a check or money order made out to the Winston County Genealogical Society for the amount of $___.___ (membership dues are $20.00 per year and $5.00 for each additional member per household) for the cost of membership dues.

Please send payment to:

The Winston County Genealogical Society
P.O. Box 112
Double Springs, AL 35553