WORSTEN
Genealogical Society
Membership Application Form
Forename (s)
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Surname
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Maiden name
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Date of birth
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Address
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e-mail
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http://
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Tel.
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Language (s)
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Research
subject (families of my ancestors)
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I wish to become a ordinary (benefit*) member of the Worsten
Genealogical Society.
I send my membership dues of ....................
for the year ..........................
by postal order to the following address:
Worsten
Genealogical Society
P.O. Box 312, PL-50-950 Wroclaw 68
Date ........................................
Signature
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We, the parents, allow our son (daughter*) to be enrolled as a member of the Worsten Genealogical Society.
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signatures of parents
