2017 Polish Genealogy Conference

Registration Form

Name______________________________________________________________

Address____________________________________________________________

City/State/Zip_______________________________________________________

Telephone Number____________ E-Mail Address_________________________

Amount enclosed___________________   Date____________________________
    

  PLEASE CHECK THE DATE(S) YOU WOULD LIKE TO ATTEND

             
Friday, October 13 only  -  $35  ______
         
Saturday
, October 14 only  -  $65  _______
        
Friday, October 13
and Saturday, October 14  - $85 _______

 Finger sandwiches, coffee, and tea are included in Friday's registration fee.

 A Polish-American buffet luncheon is included in Saturday's registration fee.                       


  *
  Please circle the lecture you would like to attend on the Lecture Selection Form.
    
  **  If you would like a consultation appointment with one of our experts, which
        must be made by September 1, 2017 and are limited,  please fill out the
        Consultation Appointment Form.  No appointments will be made the day of
        the conference.

        PLEASE RETURN THE FORMS ALONG WITH YOUR REGISTRATION
        FORM.


 
 
Please make checks
payable to PGSCTNE and mail this form with your
  payment to: 
Diane Szepanski, Conference Chair, 138 Fern Drive,
  Plantsville, CT 06479

  Please check here ______ if you would like confirmation.  Please enclose a
  self-addressed stamped envelope or provide your e-mail address above
so
  we can send you the confirmation electronically.


  Circle if you are a member of:  PGSCTNE ____  
  
  OTHER (Please state how you knew about the conference)
  ___________________________________________________


  For further information, please call Diane Szepanski, 860-919-6333 and leave
  your name, telephone number, and postal or e-mail address or e-mail us at

  Szepanski@cox.net.