PGSNYS Membership Application

Please print the following form, complete and mail with payment to:
PGSNYS, Attn: Membership Chairman, 12 Grant Road, Snyder, NY 14226
Name:______________________________________ Date:______________
Address:_________________________________________________________
City:_______________ State:____ Zip:________ Phone:( )____________
Email address:_____________________________________________________
Type of Membership requested:US – $15.00 Canadian – $18.00 International – $25.00
How did you hear about us?From a current member Website Library Other:________________
Can you read/translate any of the following languages?Polish Russian German Latin
Our surname database is posted on our website. If you wish to have the surnames that you are researching posted, please list them below:
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Please circle which form(s) of contact you would like to have posted on the website for people to get in touch with you regarding your surname research:

Mailing address Telephone number Email address