Participant Application Form

Alpharetta & Old Milton County Historical Society, Inc (AOMCHS)

Individual membership (Annual fee: $20.00)

Family membership (Annual fee: $30.00)

No Membership fee if age 80 or older

Existing member paying fee enter Name, phone number, fee amount + changed info

Membership year is from July 1 thru June 30. New members joining after Janurary 1, their fee will also cover the next year.

Type membership

Family Membership (fields to enter info for 2nd family member will appear)Age 80 or older (please enter year in Date of Birth, fee payment field will not appear )

Member Name

First Name (optionally + middle and or maiden name) Last Name

Member Date of Birth

month/day/(optional year)

Member Email address

example@example.com

Member Phone Number

Please enter a valid phone number.

2nd Family member Name

First Name (optionally + middle and or maiden name) Last Name

2nd Family member Date of Birth

month/day/(optional year)

2nd Family member Email

example@example.com

2nd Family member Phone Number

Please enter a valid phone number.

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Volunteer Opportunity Interest

Other Interest

Pay Fees by credit card or PayPal

USDAnnual Fee (add 20 or 30 to pay proper fee on-line, otherwise mail a check of $20 or $30 to:AOMCHS;1835 Old Milton Parkway; Alpharetta, GA 30009 )

Membership Application