Central Oklahoma Chapter AHSGR (Membership Form)

(Members are encouraged to join National AHSGR to help preserve our history for future generations)

Chapter membership dues are based on the calendar year. Dues are $15 per person or $20 per couple.

Name(s):__________________________________________________________________________

Address:__________________________________________________________________________

Telephone: Home: _______________________________

      Cell: _________________________________

E-mail: ______________________________________

Renewal _________ New Member _____ Individual________ Couple__________

Dues for year: 2023, 2024, 2025 (Please circle one) $ Total Amount Paid: ______________

Person 1: Family Surnames;______________________________________________________________

Ancestral Villages;____________________________________________________________________

Person 2: Family Surnames;_____________________________________________________________

Ancestral Villages;____________________________________________________________________

Are you currently a member of AHSGR? Yes___NO___ Do you plan to join AHSGR? Yes___No__

Please make checks payable to "Central Oklahoma Chapter AHSGR"

Send dues to: Paulette Schroeder, 14031 Crossing Way West, Edmond, OK 73013