JOIN SIGDALSLAG
    

Date ______________


Full Name(s) _____________________________________________________

   Street    _____________________________________________________

             _____________________________________________________

   City      ____________________  State ______   Zip ____________

   E-mail    _________________________   Phone ___________________



  BUSKERUD family origin in:   SIGDAL    EGGEDAL    KRØDSHERAD
                               (circle those that apply above)


Emigrant Ancestor's Name  ________________________________________

Farm Name        _________________________________________________

Year emigrated   ____________________




Dues for three issues JAN-DEC  (two adults at same address)

         US / CANADA    $10/YR  OR   $25/3 YR IN US$

         ELSEWHERE      $12/YR  OR  $30/3 YR, also in US dollars.

Make checks payable to:   Sigdalslag

Print this page and mail with check to:
  
     Lila Harp
     Sigdalslag Vice President - Membership
1265 11th St
West Des Moines, IA. 50265 USA