Florida Chapter of the Ohio Genealogical Society

2011 Annual Conference Registration Form

18-19 February 2011

West Melbourne, Florida

Select One:

I have paid my FCOGS 2011 Dues. ( ) $35.00

I am a FCOGS Life Member. ( ) $35.00

I am including my 2011 Dues. ( ) $47 Single or ( ) $50 Joint

only 1 attending conference

We are including our 2011 Dues. ( ) $85.00

both attending conference

I am not a FCOGS member. ( ) $45.00

I am enclosing my check, in the amount of _______, for the Florida Chapter OGS 26^th Annual Conference in West Melbourne, Florida. This fee covers the Friday and Saturday conference sessions and Saturday’s lunch.

Name: _______________________________________________________

Address: _____________________________________________________

City, State, and Zip: ____________________________________________

E-mail: ______________________________________________________

3 Ohio Counties I am Researching: ________________________________

3 Ohio Surnames I am Researching: _______________________________

Saturday’s lunch will be boxed lunches from Honey Baked Ham.

Sub Meat Choices:

___ ham ___ turkey or ___ roast beef

Side Choices

___ potato salad or ___mandarin pineapple dream salad

Drink choices

___ Coke ___Diet Coke ___Cherry Coke Zero

Mail to:

Florida Chapter OGS

c/o Leslie Harper

426 SE 28 Loop

Melrose, FL 32666-5324