PCHGS Membership Form

Please fill out the following information:
Name:
Street or P.O. Address:
City:
State:
Zip:
Phone:
Email (optional):

Check the type of Membership you would like:
	Student (Full time) $10.00
	Individual $20.00
	Family $25.00
	Business $50.00
	Patron $100.00

Amount Enclosed:

Please complete the form and submit it to:
Pierce County Historical & Genealogical Society
Post Office Box 443 • Blackshear, Georgia 31516

Questions? Email piercecounty@postmark.net
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29-Feb-2000