Date____________
Name:____________________________________________________Address:__________________________________________________
City/State__________________________________Zip_____________
Phone:______________________ Check one: ___New ___Renewal
Please indicate level of membership desired:
Regular: ____Individual............................ $12.50 per year ____Husband/Wife.................... $17.50 per year Student: ____Individual............................ $ 5.00 per year Life: ____Individual............................ $50.00 (one time) ____Husband/Wife..................... $75.00 (one time) ____Add Husband/Wife............. $25.00 (one time) Annual membership covers one year from January 1 to December 31.
Checks/Money Orders payable to Jenny Wiley Association.Mail to:
Jenny Wiley Association, Inc
c/o Janie Harlow
P. O. Box 484
Paintsville, KY 41240++Please share your family research by enclosing a copy with this application.
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