2014 MEMBERSHIP APPLICATION

for the Bolles Family Association

Membership dues are due the first of the calendar year

 

Name________________________________________________________________________ Spouse_________________________

                         (Last, First, Middle)

Street_________________________________________________ Apt./Unit#_____________City/Town________________________

State________Zip+4______________________Email______________________________________________________________

Phone(s)_____________________________________________ Bolles Genealogy Numbers (and letters) if known_______________

Children living at Home: Names/Birth dates________________________________________________________________________

 ____________________________________________________________________________________________________________

Children not living at Home: Names/Birth dates_____________________________________________________________________

 ____________________________________________________________________________________________________________

Parent’s Name________________________________________________________________________________________________

Maternal Grandparents_________________________________________________________________________________________

Paternal Grandparents_________________________________________________________________________________________

Dues enclosed are for the following years (Circle):

2009 2010 2011 2012 2013 – arrear dues are $10.00 per year

2014 – dues are $15.00 per year for hard copy of newsletter or $10.00 for an electronic version only. Renewal Membership card will be mailed.

Extra decal $2.50 ea: specify quantity ______

For New Members a Membership card and coat-of-arms decal will be mailed.

$________ Total amount remitted.

 

Please make check payable to the: Bolles Family Association

Mail to:

 The Bolles Family Association  c/o Walter Bolles
291 Camp Straus Road
Bethel, PA 19507-95665

E-Mail: membership@bollesfamily.org

Questions? E-Mail: membership@bollesfamily.org

THANK YOU!

Members in arrears will be removed from The Bolles Family Newsletter mailing list