_______ New _________ RENEWAL

Botetourt Genealogy Club

P O B 1148

Buchanan, Va., 24066

Name (s) Please Type or print Maiden Name _____________________________________________________________________

Street address: ______________________________Home Phone__________

City:______________________State:_______Zip:_______Bus.Phone:_______

Please indicate class of Membership

Individual ($10.00)

Family ($15.00)

Library or Society ($10.00)

Life Member ($100.00)

Please make check payable to: Botetourt Genealogy Club. Your canceled check is your receipt. Membership card may be picked up at the monthly meeting. If you want your card mailed, please provide a (SASE) Self-addressed, stamped envelope.

In consideration of being accepted as a member and for the duration of membership in Botetourt Genealogy Club, I pledge that:

1. I will assist in locating and preserving public and private records and in making such records available to members of this club and to the general public.

2. I will carefully refrain from mutilating, marking or otherwise defacing or destroying any part of such public or private records.

3. I will support the programs and policies of the Club.

Date:_____ Signature (s) ________________________________ (For Club Use) Date received:______ Check # ______ Amount:_____

Card #_______ Card & Packet Mailed:_____ To Treasurer _______