RENEWAL FORM

Yes, I would like to renew my membership in
The Dalzell Family Association of North America (DFANA)

Enclosed is ( )Check ( )Money Order for the period 6/1/08 – 5/31/09

DFANA Membership Year runs from June 1 through May 31

pAnnual Membership: $25 US funds only, please

Name:__________________________________________________________________

Mailing Address:__________________________________________________________

_______________________________________________________________________

City:_______________________________ State/Province:_______________________

Country:____________________________ ZIP/Postal Code:_____________________

Please make checks or money orders payable to: Dalzell Family Association of North America

Mail with this form to: DFANA
                                     Thomas Dalzell, Membership Director
                                     2529 Rosalind Ave SW
                                     Roanoke, VA 24014-2325    USA

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