RUCK ER family SOCIETY
The RUCKER family SOCIETY 2015 Dues
Make your check payable to The Rucker Family Society and send to:
Alice Rucker, Registrar, 13331 Gridley St., Sylmar, CA 91342-4529
(818) 365-7027 (Res.) • (818) 361-5185 (Fax) • e-mail aliruc@ca.rr.com
Dues for 2015 membership $15.00 (or $30.00 for 2015 and 2016, etc.)
Additional Donations for the Preservation and Memorial Fund
Additional Donations for the Rucker Surname DNA Project
Total Enclosed
(Please duplicate this form for library memberships)
Please print exactly as you would like your mailing label to appear:
Salutation: (please circle) Mr. Mrs. Ms. Miss Dr. Other:
Name:
Street Address:
City:
State:
Zip code:
E-mail address:
Membership # ___
+
New Member?
_
Phone No. (
)
Rucker Pedigree (as far back as known)
First
Middle
Last
Rucker Parent
Grandparent
Great-Grandparent
2nd Gt-Grandparent
3rd Gt-Grandparent
4th Gt-Grandparent
5th Gt-Grandparent
6th Gt-Grandparent
7th Gt-Grandparent
8th Gt-Grandparent
9th Gt-Grandparent
10thGt-Grandparent
Note: If you descend from more than one Rucker, please list on back of this form.