New Cracow Friendship
Society
New Membership Application
All new applicants must print out and complete the application form “in full”
and mail with a check** to :
NCFS c/o Ida Lewis
147-17 78 Rd.
Flushing, N.Y. 11367
**You can pay electronically via donate button below. However, completed application must be mailed to address above.
Name: ______________________________________________
Maiden _________________________
Mobile Number:______________________ DOB ________________ Circle one: 2G 3G 4G
Home Telephone Number: _________________________ Anniversary Date: ___________________
Address:________________________________________________________________________________
Ancestry names and birth place linked to Galica region: ___________________________________
_________________________________________ ______________________________________________
Spouse’s Name: ______________________________________ Maiden __________________________
Mobile Number: _______________________ DOB: __________________
Summer/Winter Address: _________________________________________________________________
Other phone number (s):
_________________________________ Months away: _________________
Children’s Names: _______________________________________________________________________
Family Membership: $40.00
Single Membership: $25.00 New Member one time fee*:
$50.00
Contribution: ______ $36
______ $54 ______$72 ______$180
______$360 ______other
$_____ Membership +
$ _____ contribution + one time fee*$__50_ = Total $
________
*A one-time initiation fee of $50 is required for new membership enrollment.
_______________________________ ____________
Signature Date
As our membership fees have been increased only once since 1965, so additional contributions are one way to defray operation costs and enable continued philanthropic work as a non profit organization: 501(c)4. All new membership must mail in a complete form and enclose check payable to NCFS or mail in application and submit payment using our donation button.
Your
membership information will only be used by the NCFS. Members in
good standing can acquire cemetery plots if available.
More information will be provided upon request.
For further assistance contact the membership committee by mail or by e-mailing.
