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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I consent to
the publication of
this information in the newsletter (Please check one) Yes___ No___
Please make check payable
to POLISH
GENEALOGICAL SOCIETY of MINNESOTA
and mail to: Michael Eckman,
Treasurer, 7222
Oak Pointe Curve, Bloomington MN
55438-3405