__ Mr. & Mrs. __ Mrs.
__ Mr. __ Miss __ Ms.

______________________________________________________________
--------------Surname----------First---------Middle-----------


______________________________________________________________
--------------Maiden-----------First---------Middle-----------


Address_______________________________________________________


City___________________State_____Zip________Phone_____________


Membership:  New________Renewal________Member No._____________


E-Mail Address:_______________________________________________


Surnames Researching:_________________________________________


______________________________________________________________


Query:________________________________________________________


______________________________________________________________


______________________________________________________________


______________________________________________________________


Quarterly Suggestions:________________________________________


______________________________________________________________
==============================================================

Please include my name, e-mail address, and surnames on the
KVGS member surnames webpage. 

____________________________________     _____________________
------------Signature---------------     ---------Date--------


____________________________________     _____________________
------------Signature---------------     ---------Date--------