SEND THIS FORM AND CHECK TO: 
Vilma Luck
14281 120th Place
Kirkland, WA 98034

Please make check payable to Greater Seattle Chapter, AHSGR.

Name_____________________________________Telephone________________________

Address___________________________________________________________________

Ancestral Village (Husband)_________________________________________________

Ancestral Village (Wife)____________________________________________________

Life Member: Yes__________ No___________

Current Member of International AHSGR: Yes________ No__________

Enclosed Find:
______International AHSGR Dues $50.00
______Greater Seattle Chapter 10.00 [total $60.00]

Thank you, we appreciate your membership in our Chapter!