National Grigsby Family Society

Incorporated 1981, in The Commonwealth of Virginia

MEMBERSHIP FORM

Phone No. _____-_____ - _________ e-mail ID___________________________

Check one:

Mr.

Mrs. ________________________ __________________ ________________ __________________

Miss Last Name First Name Middle Name Maiden Name (if applies)

______________________________________________________________________________________

Street Address or Box Number City State 9-digit Zip Code

____________________________________________________________________________________________________________

Names of Children Under Age 21

Membership includes spouse and children under age 21. There are no differences in services among the membership categories.

Honorary Member Age 80 or over – NO DUES________

Sustaining Member Annual Dues of $25.00________

[Life Membership information will be sent upon request]

We would appreciate copies of additional information you are willing to share, to add to our Grigsby files:

Family Record Sheets, 5-Generation Charts, narrative history of your familly line, copies of Bible records and other documentation, newspaper articles, etc. We will copy and return your material if you cannot have copies made.

Mail this completed form, with check and other material to:

David Bushey, NGFS Administrator

10478 Courtney 

Fairfax, VA 22030

[Phone: 703.273.2876 email: administrator@grigsby.org]

How did you hear about the National Grigsby Family Society:__________________________________

PLEASE ENTER YOUR KNOWN FAMILY DATA IN THE FORM ON

THE BACK OF THIS SHEET

(over)