SLOVAK SOCIETY OF COLORADO
Application for Membership for 2007
Check one:
__ New Member __ Renewal __ Gift Subscription
__ 1 year @ $20.00 for family
__ 1 year @$10.00 for individual or
__ $100 for a Lifetime Membership for an individual or family over age 65.
Only one person in the family needs to be over 65.
Check here if you want part of your money to be a donation for the Fund for
Special Projects. __ amount
Name:
Address: ______________________________________
______________________________________
City / State: ______________________________________
______________________________________
Check here if new address: ____
Telephone: (H) ___________________________________
Email: ______________________________________
Check here if new email address: ____
Ancestral village, town, city in Slovakia: ______________
Foreign Language Fluency: _________________________
Make check payable to: Slovak Society of Colorado
Mail to: Diane West, Treasurer,
3014 Redstone Lane; Boulder, CO 80305