Application for Membership
The "Penland Historical Society, Inc."
______ New Member

______ Renewal

Name___________________________________________________________________________________

Street  Address_________________________________________________________________________

City/State/Zip_______________________________ E-Mail Address_____________________________

Phone_____________________________ Type of Membership__________________________________

Dues Enclosed  $____________________ Signature___________________________________________

Make Check Payable to:   The Penland Historical Society, Inc.             ANNUAL  DUES

MAIL  CHECK  TO:                                                                                                                                       Individual   $ 10.00
                                                                                                               Family         $ 15.00
  Charles  Penland                                                                                        *Sustaining  $ 50.00
  15612 Echo Lane
  Selma, Texas  78154

  New Members:  Please give as much information as you can about your family.  Use another page
of paper if there is not enough room on this form.  We will use the information to determine your
branch of the Pen(t)land family.   Some, or all, of the information you provide may be published on
the web-site to assist others in determining their their heritage.
_____ I do    _____ I do not wish to have any of my information published on the web-site.

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My Lineage

My Sisters___________________________________________________________________________
My Brothers_________________________________________________________________________
Mother_________________________          ____                    born on_   _____             Place_____________________
Father____________________________                               _born on _  _____             Place_____________________
Maternal Grandmother________________              ______born on___            ______Place_________________
Maternal Grandfather________________________             born on ____             ____Place__________________
Paternal Grandmother_______________________              born on____            _____Place__________________
Paternal Grandfather_________________________             born on             ________Place___________________
Other known ancestors_____________________              _born on _           _______ Place___________________
_____________________________________________              ___born on __           _____ _Place_________________
____________________________________________              ____born on ____          _____Place________________
_____________________________________________              ___born on___         _______Place _______________