Membership Application:

Date:______________

New Membership ___ Renewal____

Name:________________________________

Address:___________________________________

___________________________________________

Phone:________________________

Email Address:_____________________________

Annual dues are $8.00 for a single membership, $10.00 for a family membership.

(We operate on the calendar year).

Please print, fill out, and mail with payment to:

TAN Historical and Genealogical Society

c/o Fran Schippers

10603 Eastern SE

Wayland, MI 49348

(Please make checks payable to: TAN Historical and Genealogical Society)