The Welsh Society of Greater Cincinnati

Cymdeithas Gymreig Cincinnati A'r Cylch


( Please print off this form and mail it, with your enrolment check, to the address at the bottom of the page )
Family Name:
Street:
City: State: Zip:
Email: Tel:

Title:
Mr., Mrs., Ms., Dr., Rev.
First Name:

Middle Initial:

Gender: M / F

Interests:
e.g. Welsh language, Welsh music, Welsh history, genealogy

For family membership, fill out as many rows as there are family members applying.
For single membership, fill out only the top row of the grid.

Type of Membership: ( please check one )
Family: $ 20
Single: $ 15

Please make checks payable to: The Welsh Society of Greater Cincinnati
and mail to: Ms. Holly Pratt,
WSGC Treasurer,
4465 West Fork Road,
Cincinnati, OH 45247
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