Polish Genealogical Society of Michigan
_________________________________
Membership Application/Renewal Form
Full
Maiden
Name ______________________________________ Name ____________________
Street
Address_____________________________________ City______________________
State ___________________________
9 Digit Zip Code ___________ - __________
Telephone (_____) _________________
Email_______________________________
(Will not be published
____________________________________________________________________________
Membership is for one (1) year , commencing from the receipt of fees
You will receive issues our Journal THE POLISH
EAGLET with your membership.
_____Household (U.S.) = $25.00 _____Household (Canadian) = $30.00 ____Lifetime =
$300
Note:
Canadian Members, Please remit your dues in U.S. funds
_________Household (Foreign-Other than Canada) - Please write for Membership
cost
Please do not staple your checks.
__________New
___________Renewal
________________________________________________________________________
Office Use: Cash Check Money Order #___________ $_________Date___/___/_____
Mail To: PGSM - Dept.W
Burton Historical Collection
c/o Detroit Public Library
5201
Woodward Ave.
Detroit
MI 48202-4007 USA
List surnames you are researching: ____________________________________
___________________________________________________________________
Submit
a Query: _____________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
