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Membership Application

Consider a contribution to the Library Fund with your 2010 membership
Print this form and submit with your check to the address at the bottom.




____________Individual/ Family   $20.00/one year or $50/three years

_____________Sponsor $25.00 **************______New ______Renewal
 

Name:________________________________________________________________

Address:______________________________________________________________

City:____________________________State_______________Zip__________-______

Phone______________________________  E-Mail_____________________________
 
 

 List Surname from Poland you are researching: (one line for each surname)

 List locality in Poland where each surname originated

 List locality in North America where immigrant settled

Sample GORAL ............................. Nur, Lomza ............................. Minneapolis, MN

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Please make check payable to POLISH GENEALOGICAL SOCIETY of MINNESOTA
and mail to: Michael Eckman, Treasurer, 7222 Oak Pointe Curve,  Bloomington MN 55438-3405