GSHA LOGOGenealogical Society of Hispanic America
P.O. BOX 3040
Pueblo, CO 81005

a 501(c)(3)non-profit corporation established in 1988 and incorporated in the state of Colorado.
[Federal tax ID 74-2512579]
return dues & application to the above address
MEMBERSHIP APPLICATION

Date:_______________ NAME:______________________________________________________
Maiden Name (if applicable):_________________________Spouse:________________________
Street Address:__________________________________________________________________
City:_______________________State_____________________9 digit zip___________-_______
Tel. NO.:(___)_______________Fax:(___)______________Email:___________________________
circle one:   NEW   or   RENEWAL Membership -for year___________
How did you hear about us?________________When did you begin your research____________

National membership is on a calendar year basis and dues are paid annually. Members renewing
or joining GSHA after March 31 should contact the membership chair Rita Morales (719)821-2299 for
information on how to obtain society publications published before their enrollment.
visit our website at: http://www.gsha.net
PLEASE MAKE ALL CHECKS PAYABLE TO: GSHA
Dues schedule as follows (check the correct membership category):
      Individual           $25      Libraries and Institutions $25.00
      Family              $30       Students $20.00
      Senior Individual (over 62) $22       Associate $25.00
      Senior Family (over 62) $27       Sustaining $37.00
      upgrade to Family Membership $  5       **Donation  
                          TOTAL PAID $
                        Cash or Check #                  

          **If you are affiliating with a chapter make sure to note whether you wish your donation to go to the Chapter or the National.

We encourage you to affiliate with the chapter whose meetings you plan to attend, or with a chapter you wish to support
financially.(Your designated chapter receives 20% of your national dues.) If you are affiliating with GSHA-SC, please add an
additional $5 to cover the fees for extra chapter services and mail your check directly to GSHA-SC at the address listed below.

Chapter Affiliation (check one):
MAL_____.GSHA-FAC-Pueblo________.GSHA-SC________(add an additional $5 to all dues categories)
All members are entitled to the following benefits: Nuestras Raices quarterly journal, and Noticias de Nuestras
Raices national newsletter, discounts to our GSHA Annual Meeting and National Genealogical Conference.
Members not affiliated with a chapter are listed as Members-At-Large. The current chapter affiliations are:
GSHA-Fray Angelico Chavez-Pueblo Chapter. PO Box 3027, Pueblo, CO 81005home page
GSHA-Southern California, PO Box 2472, Santa Fe Springs, CA 90670home page

See Reverse Side for Inclusion in GSHA National Surname Network Roster
( rev. February 10, 2006)