Applicant Information

First Name*

Last Name*

Company Name




Zip Code*

Phone Number*

Email Address*


Do you provide genealogical services?
Select one: yesno

Are you currently accepting clients?
Select one: yesno

Do you manage record collections?
Select one: yesno
If yes, for which organization?

Website Listing*

We publish a listing of members’ names, contact information and research services on our website. Please select one of the following three options:
Please list my name, contact information and services on the CPGC websitePlease do not include me on your websitePlease include my name and services on the CPGC website, but allow me to specify which fields display

Do Not Display Street AddressTown/State/ZipPhoneEmail

Research services: Please list your research services as you would like them listed on the website. (120 character limit)

Volunteer Opportunities

Let us know if you would like to
Distribute CPGC brochures in your areaVolunteer with NERGCParticipate in our Ancestor Road Show



How will you pay for your membership?
Select one: PayPalCheck

Click the SUBMIT APPLICATION button to submit the form and advance to payment options.