CFA Membership Form

Cogswell Family Association

crest1.GIF (12460 bytes) A non-profit corporation, organized in Mass., in 1989, dedicated to preserving the history of the Cogswell family

Print out this membership form, complete the appropriate fields, and mail to:

Cogswell Family Association, Inc.
21321 107th Avenue SW
Snohomish, WA 98296-7140

Name: __________________________________________________

Address: ________________________________________________

City: ___________________________ State/Province: ___________________

Zip/Postal Code: __________________

Please check one: Residence Business

ANNUAL DUES FOR CALENDAR YEAR 2013
Payable upon receipt

NEW MEMBERSHIP - $10.00

SINGLE MEMBERSHIP RENEWAL - $20.00

FAMILY MEMBERSHIP RENEWAL- $30.00

BENEFACTORS - ($1,000.00 / Exempt from annual dues) Total Enclosed $ _________

Please Include Birthday:_____________________

Please Include E-Mail Address: ___________________________________

Please indicate your relationship to John & Elizabeth Cogswell (arrived in American 1635):

Can document lineage to John & Elizabeth

Believe to be related, but cannot currently document lineage

Know not to be related to John & Elizabeth

PLEASE MAKE ALL CHECKS PAYABLE TO:

Treasurer, Cogswell Family Association, Inc. PLEASE RETURN WITH PAYMENT

OR
You can now pay your dues by PayPal.

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