Please print, fill out and mail to:

		THE HARPER COUNTY GENEALOGICAL SOCIETY
			Attn: Gail Bellar
		  1002 Oak Street - Harper, KS  67058

		       APPLICATION FOR MEMBERSHIP

        Dues are $10.00 per year, January 1 to December 31.

		New Membership _____         Renewal _____

NAME:______________________________________________________________________
	(Last)                   (Middle)                (Maiden)

ADDRESS:___________________________________________________________________

CITY:______________________________ STATE:___________ ZIP + 4 _____________

PHONE NO.: _____________________________E-mail:____________________________

List the Surnames you are researching:

       SURNAME             YEARS             STATE           COUNTY

1.  _______________________________________________________________________

2.  _______________________________________________________________________

3.  _______________________________________________________________________

4.  _______________________________________________________________________

Please list below back issues you wish to purchase:

1.  _______________________________________________________________________

2.  _______________________________________________________________________

3.  _______________________________________________________________________

4. _______________________________________________________________________

List Complete Years:___________________________________________________________

Use additional paper if necessary)

              Back issues of the Harper County Connections Newsletter 
                           are available at $2.50 each.  
              
MEMBERSHIP . . . . . . . . . . . . . . . . . . . . . . . . . $_________
BACK ISSUES. . . . . . . . . . . . . . ______ @ $2.50 ea . . $_________
	Includes Postage				
					     TOTAL ENCLOSED  $_________

	"THANK YOU"