Membership Form

Please print, fill out, and mail to:

Slovak Heritage Society of NEPA

    PO Box 5004, Station A

Wilkes-Barre, PA 18710-5004

Name:                                                                                                                                            

Address:                                                                                                                                        

Telephone #:                                                                                                                                 

Email:                                                                                                                                             

Annual Dues:    $ 10.00        students $ 5.00        Organizations $25.00

Amount Enclosed:                              

Please circle your Slovak Heritage interests.

            Cooking Class                               Lectures - Films

            Craft Class                                      Music

            Cultural Trips                                 Slovakia Tour

            Language Courses                       Other (please specify)