Johnson County Genealogical Society and Library, Inc.

IMPORTANT NOTE: New members will be provided with a USERNAME and PASSWORD. Please be patient as this may take a few days before the application is processed. Thank you.

Personal Information:

First Name:	Required
Last Name:	Required
Family Member First Name:	"Family" Membership Only
Family Member Last Name:	"Family" Membership Only (if different)
Address:	Required
Address 2:
City:	Required
State / Province:	Required
Postal Code:	Required
Home Phone:	Formatted as (000) 000-0000
Cell Phone:	Formatted as (000) 000-0000
Email:	Required

Membership Dues (select one):

Dues are paid on an annual basis running January 1 to December 31. Partial year dues are available after July 1st for NEW members only.

Registration Type:

New

Renewal

Please make a selection.

	Full Year	Partial Year	(July 1 to Dec. 31 for New members only)
Individual:	$20.00	$10.00
Individual w/ Quarterlies by Mail:	$30.00	$15.00
Family:	$25.00	$12.50
Family w/ Quarterlies by Mail:	$35.00	$17.50

Please make a selection.

Security Code / Place Order:

Check box & enter code:

Required