OBCGS Membership Application

Please print out this page and mail it to our Post Office Box with a check made out for the appropriate amount. OBCGS is not setup to take credit cards or on-line applications.

Membership Dues

Individual		$ 30.00
Family		35.00
Life Membership	Under 40	400.00
	40-59	350.00
	60-69	250.00
	70+	200.00
* Additional Postage required outside the United States.

Name:_______________________________________________________
(please print )

Address: _____________________________________________________

City:______________________ State:___________ Zip Code:__________

Phone (____)_____-_________ County:_________ E-Mail:_____________

_____

I want the contact info above & surnames below printed in Old Buncombe Co. Gen. Soc.’s journal "A LOT OF BUNKUM". This must be checked & signature below to be included.

Surnames:__________________________________________________________________________________

(please list surnames if you want them included)


_____	I wish to receive the newsletter, BITS'O'BUNCOMBE via e-mail instead of regular mail. This must be checked & signature below to *receive BOB via e-mail NOTE: This is the newslettter, NOT the quarterly journal, A LOT OF BUNKUM.*

Signature_______________________________________________

This box is for office use only:

$ Paid______________ by__________

Cash____________Ck#____________

New________Renew______Year_____

Back Issues: Yes_______ No_______