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The Curtis/s Family Society
Membership Application

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Please print this form, and after completing, mail it and check to the Membership Secretary.

Make your check out to: Curtis/s Family Society

Cheryl Behrend
Membership Secretary
17924 SE 89th Rothway Ct.

The Villages, FL 32162-4840

(Questions? Contact Cheryl at: c.behrend@comcast.net)

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This is a:  Box  New membership Box Renewal

Membership type:  Box   Single [ $20/year, 3-years/$50 ]  

 Box  Couple [ $25/year;3-years $65 ]    Box  Life [ Single only; $250 ]  

 

Name:   __________________________________________________________

Spouse Name:   ____________________________________________________


Address:   _________________________________________________________

City:   __________________________  State:  ________Zip: _________ Country_______

Email address:   _________________________________Phone:   (       )  ________________

http://curtis-curtiss.org/pub/webgraphics/lines/500x3.gif

Immigrant ancestor + Curtis Line or Curtis ancestors (if known) and Dates

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