Irish History DVD Project

Membership Application




Applicant name___________________________________________

Address__________________________________________________

City______________,State or Province________________________

Country______________________Postal Code__________________

Phone__________________________ E-Mail_________@_________

I have read about the purposes of The Irish History DVD Project an agree with it's aims.

Signature_______________________________________________________________

Type of membership requested (Please check your choice)

( Student or Unemployed $5.00 USD		( Regular	 $20.00 USD		

( Academic $15.00 USD			( Founding $50.00 USD or more 

Please send appropriate amount to:

Irish History DVD Project		Make payment in US Dollars out to: Irish History DVD Project
C/O FMG						Membership Card sent to address given above.
118 South Main Street
Enterprise, Al. 36330, USA