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Return With Your Payment to:
ACGS Membership Secretary
PO Box 6478 Manchester NH 03108-6478
Or you may call (603)622-1554 to pay with a credit card.
Name __________________________________________________________________________Date__________________________
Maiden Name(if appl.) _______________________________________________________________________________________
Address _____________________________________________________________________________________________________
City _______________________________________________State __________ Postal Code ____________________________
Country ______________ Tel.(______)_________________ Email Address __________________________________________
Your Occupation _____________________________________________________________________________________________
Your Birth date/place* _______________________________________________________________________________________
Your Marriage date/place* ____________________________________________________________________________________
Your Father _________________________________________________________________________________________________
Your Mother (maiden name) ___________________________________________________________________________________
Their Marriage date/place* ___________________________________________________________________________________
Your Spouse (maiden name if appl.) __________________________________________________________________________
Your Spouse's Father ________________________________________________________________________________________
Your Spouse's Mother (maiden name) __________________________________________________________________________
Your Paternal Grandfather ___________________________________________________________________________________
Your Paternal Grandmother (maiden name) _____________________________________________________________________
Their Marriage date/place* ___________________________________________________________________________________
Your Maternal Grandfather ___________________________________________________________________________________
Your Maternal Grandmother (maiden name) _____________________________________________________________________
Their Marriage date/place* ___________________________________________________________________________________