------------ REGISTRATION FORM (website generated)------------------
2008 StLGS Speaker Series Registration
Saturday, 11 October 2008
Please print or type. Use a separate form for each person.
Name: ______________________________________________________________
Address: ____________________________________________________________
City: _______________________________________________________________
State & Zip: _________________________________________________________
Phone: _____________________________________________________
E-Mail:_____________________________________________________________
Registration Fees
| Registration | Members | before 15 Sept. | $45.00 | ________ |
| Members | after 15 Sept. | $60.00 | ________ | |
| Non-Members | before 15 Sept. | $55.00 | ________ | |
| Non-Members | after 15 Sept. | $70.00 | ________ | |
| Charitable Donation to StLGS (tax-deductible) | ____ | ________ | ||
| Membership Dues | Individual | $35.00 | ________ | |
| Total | ________ | |||
Form of payment:
___ Check ___ Cash ___ Visa ___ MasterCard
Credit Card Number: _____________________________ Exp. date: ______________
Print Name (as it appears on credit card): _______________________________
Signature ____________________________________________
Make checks payable and mail check along with this completed form to:
St. Louis Genealogical Society, P.O. Box 43010, St. Louis, MO 63143-0010
StLGS Speaker Series Page