Ringerike - Drammen Districts Lag Membership Application

Family Origin Information
Membership Application for Ringerike - Drammen Districts Lag Dues are $12.00 per year, $33.00 for 3 years or $50 for five years. Membership Year Jan. 1 to Dec 31 Please print this form, fill out and mail to address below
Name				Date
Renewing Member [ ] <-- Check one --> New Member[ ]
Street		Phone
City		Email
State and Zip Code
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Family origin in R-DD if known - circle only one. Ringerike, Hole, Modum, Øvre Eiker, Nedre Eiker, Hurum, Lier, Røyken, Drammen
Ancestor's Given Name & Patronymic	Farm Name		Birth parish if known	Year Emigrated



May we include your information in our R-DD member database? Yes___ No___

Mail with check payable to Ringerike - Drammen Districts Lag to Barb Gulbrandsen 1579 Lorane Lane White Bear Lake MN 55110