Cambrian Heritage Society: Membership Form

Name(s)____________________________________________________________

Address____________________________________________________________

____________________________________________________________________

City ______________________State __________________ Zip_____________________

E-Mail address (please print)

_____________________________________________________________

Telephone number________________________________________________

____ I / We wish to join the Cambrian Heritage Society as new members and receive its newsletter, Newyddion Cymreig. and Membership Directory..

_____I/ We wish to renew membership of the Cambrian Heritage Society and receive its newsletter, Newyddion Cymreig. and Membership Directory.

______ Enclosed are dues for the year ($10 for an individual, $15 for couples or families)

Dues enclosed $_________________ ............Date paid__________________________

Please print out this form, complete it and send it with your check to the treasurer of the Cambrian heritage Society, Ellen Lloyd:

Ms. Ellen Lloyd
P. O. Box 244
Friesland, WI 53935-0244