Name____________________________________________________________________________________________ 

Telephone _________________________________________

Address__________________________________________________________________________________________

City__________________________________________________  State & Zip _________________________________

  
I am a member of TGS.       ($20.00)     [       ]    Member # ____________

I am not a member of TGS  ($25.00)     [       ]

Total amount enclosed _____________________

Make check payable to Topeka Genealogical Society and send it to:
TGS PO Box 4048, Topeka, KS  66604-0048 
(Your cancelled check is your receipt)

FOR SOCIETY USE ONLY:

Registration # ______________________ Check/Money Order # __________________________________

Date of Check___________________________________________