St. David's Society
                                Lackawanna County, PA
                                                                  (Founded 1910)


                                 Membership Application


Name:___________________________________________________________


Address:__________________City_______________State________Zip________


Telephone: (     )____________Email________________


Are you of Welsh descent?  ____.  (This is not a requirement for membership.  You need
only have a desire to learn about and further Welsh culture and history. )

If so, please let us know where your family lived in Wales: __________________

Were you a member previously  ______ ,or a member of another Welsh group?  Let us
know of your other Welsh affiliations.  _____________________________


Please return this application with your $10.00 annual membership payable to:

                 St. David's Society of Lackawanna County
                                
                                                  C/O

                                      Beverly Rugletic
                                     407 Baker St.
                                     Taylor, PA 18517


Your membership helps to ensure continued efforts to honor and perpetuate the culture
and history of our Welsh heritage.


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