Technology Sponsor of the Month Form

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Business Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Contact Person *

First

Last

Phone

Email *

Website / URL

Notification Choice

Purchase Sponsorship

Additional Donation

Total

$0.00

Please submit this form online and then you wil be forwarded to Paypal to submit your dues of $50.

To send by mail - Print this page and send the print out and your check to:

Campbell County Historical Genealogical Society
8352 East Main Street
Alexandria, KY 41001

Make checks payable to:
The Campbell County Historical and Genealogical Society

The Campbell County Historical and Genealogical Society is a 501(c)3 non-profit corporation.
Our Federal Tax ID is 61-1178122.
Thank You!