CSGSA Membership Form

This form is provided for your convenience. You may fill it in, print it, and mail it to the address
at the bottom of the page.

Name:  
Address:  
City:  
State:       Zip/Postal Code:  
Country (if not U.S.):  
Phone:  
E-mail:  
Personal Website URL:  

Permission to include my Name/Information in a Member List:     
and in the CSGSA Surname Index:  

Membership - One year   $20.00

Supporting Sponsorship (circle one)

$50,      $100,      $200,      $500,      $1,000

Volunteer Committee Interests

   Journal             Hospitality            Membership           Fund Raising
   Education         Program                Computer              Resources         Projects            Audit                     Public Relations

        SURNAME                       LOCATION(S)                   LOCATION(S)
     RESEARCHING                    IN EUROPE                      ELSEWHERE
(Example: Platzky(Plachy)    Lochim, Domazlice, Boh.             Chicago, IL                                                                                                            

Specific resources you can share with CSGSA members (i.e. translation skills, books,
maps, experience researching census, immigration records, newspapers, vital & church
records, artifacts, handcrafts, music, folk costumes, etc.)

Make checks payable and mail to:

CSGSA
c/o Celeste Sampson, Treasurer
7311 N. 69th Drive
Glendale, AZ 85303

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