To Register as a Member
in the Wilno Heritage Society,
PLEASE PRINT THIS FORM
AND MAIL TO THE ADDRESS BELOW
ALONG WITH YOUR PAYMENT OF DUES...
Membership in the Wilno Heritage Society
Dues are $10 annually per person; $15 family [same address] or $25 sponsor [sponsors are those who wish to
contribute more to the projects of the Wilno Heritage Society. Contributions help fund the Polish Kashub Heritage Museum and Reference Library. Sponsors will be listed in the next newsletter].
Cheques should be made to the: Wilno Heritage Society
and mailed c/o Mildred Petroskie, Box 227, 17 William St. Killaloe, ON, K0J 2A0
Please Indicate whether you wish to register as
Single $10 ( ), Family $15 ( ) or Sponsor $25 ( )
and include
Your NAME :
ADDRESS [include 911 address]:
TELEPHONE # & EMAIL:
You may also give a gift membership to family /friends.
For each gift recipient, add $10 Single ( ), $15 Family ( ) or $25 Sponsor ( ) and include:
NAME of Gift Recipient:
ADDRESS:
TELEPHONE #: & EMAIL