JERSEY COUNTY HISTORICAL SOCIETY
MEMBERSHIP APPLICATION
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Name _______________________________________________________________________________
Street or Box #_______________________________________________________________________
City, State & Zip _____________________________________________________________________
E-mail Address _______________________________________________________________________
Phone _______________________________________________________________________________
Surnames
Researching ________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Lifetime Membership is $150.00
Annual Membership per person is $15.00
AMOUNT PAID _____________________
Make checks payable to: Jersey County Historical Society
Jersey County Historical Society
601 North State Street
Jerseyville, Illinois 62052
Phone 618 498 3514