The
Bradt Family Society
Application for Membership / Renewal
Check one:
Type of Membership:
Regular____ Renew Regular ____
Associate ____ Renew Associate ____
Check one:
____
I would like to join, or continue my membership in, the Society and enclose my $10.00 check for the annual dues.
____
I would like to join, or continue my membership in, the Society and have you send me a Society Certificate.
I enclose a check for $20.00 ($10.00 for annual dues and a $10.00 contribution for Certificate.)
Please print your name clearly the way you would like it to appear on your Certificate.
Your Name: ___________________________________________________
Name
of your ancestor (regular members only): ALBERT ____ ARENT ____ BOTH _____
_____
I would like to make a contribution of $______ to help with Society expenses such as the newsletter and website.
Recapitulation
Dues
($10.00)
$_________
Certificate ($10.00)
_________
Contribution
_________
TOTAL
$_________
Name:
___________________________________________________
Address : __________________________________________________________________________
City, State, Zipcode: _________________________________________________________________
Tel: _____________________
Email address: __________________________________________
Please return this form to Anne Holzinger,
3425
22nd Avenue S, Minneapolis MN 55407.
