PUGET SOUND WELSH ASSOCIATION (PSWA)
MEMBERSHIP APPLICATION
(Print this form and mail with check to the address below)
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Membership is open to anyone interested in the Welsh culture and heritage. 
PSWA is a non-profit, tax-exempt organization (501c(3)). Contributions may be tax-deductible. Your membership dues include a subscription to PSWA's newsletter, 
Y Ddolen, published nine times a year.

Check your newsletter mailing label for your membership renewal date. If you move, please let us know your new address as soon as possible—the Post Office charges to forward bulk mail. For memberships outside the U.S. or Canada, please add $5 for a 1-year membership, $50 for a life membership. Diolch yn fawr iawn/thank you very much!
Please make check payable to PSWA and return with this form to:
Puget Sound Welsh Association PO Box 27725, Seattle WA 98165

Name____________________________________________________________________________________________________

Address__________________________________________________________________________________________________

________________________________________________________________________________________________________

City_______________________________________State_________________________________Zip______________________

Email___________________________________________________________________________________________________

Phone (day)_______________________________________________________________________________________________

Phone (evening)___________________________________________________________________________________________
 
 Puget Sound Welsh Assocition  T-Shirts: 
$15.00 donation +$3.00P&H per t-shirt 
(indicate how many & size)

____SM____MED____LG ____XLG


MEMBERSHIP AMOUNT
____1 year single ($10)___________
____1 year family ($15)___________
____ Life ($100)________________
____Overseas Postage____________
____General Fund_______________
____Memorial Scholarship__________
____T- Shirt Total________________
____Fund in memory of ___________

TOTAL ENCLOSED $ _______________

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