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	THE WILNO HERITAGE SOCIETY REGISTRATION FORM


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To Register as a Member
of 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

Annual dues are $15 for members or $25 for sponsors [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 payable to the: Wilno Heritage Society
and mailed to:
Wilno Heritage Society c/o Beverly A. Glofcheskie, PO Box 232, 6 Biernacki Mountain Road, Barry's Bay, ON, K0J 1B0

Please Indicate whether you wish to register as
Member $15 ( ) or Sponsor $25 ( ) or $_____________
and include

Your Name:
Address (include 911 address):
City	Prov./State
Postal Code
Telephone:
E-mail address:

You may also give a gift membership to family /friends.
For each gift recipient, $15 Member ( ) or $25 Sponsor ( ) and include:
NAME of Gift Recipient:

Gift Recipient Name:
Address (include 911 address):
City	Prov./State
Postal Code
Telephone:
E-mail address:

THE WILNO HERITAGE SOCIETYREGISTRATION FORM

To Register as a Member of the Wilno Heritage Society

THE WILNO HERITAGE SOCIETY
REGISTRATION FORM

To Register as a Member
of the Wilno Heritage Society