AHSGR Membership Application _______(year)

Covers the year from January 1st through December 31st 

Name:_______________________________________________________________________________

Address:______________________________________________________________________________

City/State/Zip:_________________________________________________________________________

Phone:_________________Birth Month________________(Mr.)_____(Mrs.)______________________

Ancestral  Village(s):___________________________________________________________________

Surname(s):__________________________________________________________________________

Enclosed find:
______$5.00 per person for Olympic Peninsula Chapter Dues
______$10.00 per family for Olympic Peninsula Chapter Dues
______$50.00 for 2000 International Dues
______$2.00 late charge for dues received after January 31 for renewals
______Check here if you have sent dues in to International

We will accept both Chapter and International Dues.
Please mail your remittance to the address below or bring it to a chapter meeting.