SOCIETY FARSAROTUL MEMBERSHIP APPLICATION

A $5.00 initiation fee and $18.00 annual dues ($9.00 for students) must accompany this application. First year's dues cover the remainder of the calendar year in which they were paid, i.e. until December of that year; a new billing will be issued in the next January for the following calendar year. Your copy of the By-Laws will be forwarded to you following approval of your application.

Please print and fill out this form, include a check payable to SOCIETY FARSAROTUL and mail to:
THE SOCIETY FARSAROTUL
PO Box 753
Trumbull, CT 06611

Last Name:                                            First Name:                                   Middle:                         

Address:                                                                                                                                             

City:                                                        State:                                               Zip:                              

Date of Birth:                                         Place of Birth:                                                                    

Father's Name:                                                                                                                                  

Father's Place of Birth:                                                                                                                     

Mother's Maiden Name:                                                                                                                 

Mother's Place of Birth:                                                                                                                   

Applicant's signature:                                                                        Date:                                     

Sponsoring Member (if any):                                                            Date:                                     


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