NAME: _______________________________________________________________________
ADDRESS: ____________________________________________________________________
CITY: ______________________________________STATE: ______ ZIP: _______________
TELEPHONE: ________________________ E-MAIL: ________________________________
DUES: Please circle your choice.
Individual Membership
$15.00
Individual Family Membership $25.00
Amount paid $ ______________________ Date paid _____________________________
Checks should be made payable to CCHGS. (Memorials and Donations are also accepted. )
Please list any names/surnames that you may be researching in Cleveland County.
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Please list any historical documents or information; school, church, or community histories; or artifacts that you may be willing to share with the CCHGS or on which you would be willing to give a program.
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