PLEASE PRINT THIS FORM AND MAIL THE COMPLETED FORM WITH YOUR
DUES TO THE ADDRESS LISTED AT THE BOTTOM OF THIS FORM

ST. DAVID'S WELSH SOCIETY OF GEORGIA
MEMBERSHIP FORM
Type of Membership:
NEW_____                                                                                      RENEWAL_____

SINGLE ($20/YEAR )  ____                                                    FAMILY($30/YEAR )____

NAME                                                                                                                                                       
ADDRESS                                                                                                                                        

CITY                                                                  STATE                  ZIP                                 

HOME PHONE(      )                                                  

WORK PHONE(       )                                                 

E-MAIL ADDRESS                                                                                                                                      

OCCUPATION                                                                                                                                  
WE WOULD LIKE TO KNOW MORE ABOUT YOU !!
PLEASE TELL US ABOUT YOUR WELSH INTERESTS, BACKGROUND, FAMILY,
JOB, HOBBIES, TALENTS --- ANYTHING AT ALL.

                                                                                                                                                            

                                                                                                                                                            

                                                                                                                                                         


                                                                                                                                                            

                                                                                                                                                            

                                                                                                                                                            

MAIL WITH PAYMENT TO:

Tony Nicholls
TREASURER, SDWS-GA
4363 Moss Ridge Ct
Roswell,GA 30075

(Please make checks payable to: St. David's Welsh Society of GA)