Street Address:___________________________________________________
City / State / Zip __________________________________________________
Please Check off one:---- NEW ______ RENEWAL ______
Additional Contributions:
Contributor $ 1 to $ 49 _______
Donor $50 to $ 99 _______
Patron $ 100 to $ 249 _______
Sponsor $ 250 to $ 999 _______
Benefactor $1000 and above _______
Enclosed Home Phone#:________________________________________
Work Phone#:_________________________________________
Fax#:________________________________________________
EMail Address _______________________________________
How Long have you been searching? ______________________
Please list the surnames, locations and time periods you are researching:
_______________________________________________________________
_______________________________________________________________
Send your order, check payable to Hispanic Genealogical Society: