| Once you have printed out your Writing Home search results and highlighted the name(s) of interest, complete this form and mail it to the address below. Include a check for a $5 (U.S.) donation (PGSA member) or $8 (U.S.) (non-member) per highlighted name. The donation is used for the costs of supplies, equipment, and materials. If you are not a member, please consider joining the Polish Genealogical Society of America, and taking immediate advantage of membership benefits. Are you a PGSA Member? Yes____ No______ If yes, membership #________ Amount submitted: $ ______ Please make check out to PGSA. Email Address:_____________________________________ Name_______________________________________________________ Address _____________________________________________________ _________________________________________________________________ Please note that requests without the Writing Home search results will be returned. Please send your order (completed form, Writing Home search, and check) with a Self Addressed Stamped Envelope to: PGSA 984 N. Milwaukee Avenue Chicago, IL 60642-4101 
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