___Yes, begin my membership in The Dalzell Family Association of North America
___Please enter a Gift Membership to the person/family shown below
___Please RENEW my DFANA Membership
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Annual Membership: $25 US  funds only, please              

(DFANA Membership year runs from June 1 through May 31) 

Name:_______________________________________________________________

 
Mailing Address:_______________________________________________________

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City:_______________________________  State/Province:_____________________

Country:___________ ZIP/Postal  Code:____________ Phone:___________________ 

E-mail:______________________________ FAX:____________________________

Personal or Family Information (optional):  DFANA maintains a database of members and
their family ties.  Please add any information that you might want to share, such as family connections, family history, where born, dates, occupation, profession, etc.
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Please make check/ money order payable to:  Dalzell Family Assoc. of North America
Mail with this form to:  DFANA, c/o Thomas  Dalzell, Membership Director
                                     2529 Rosalind Ave SW,  Roanoke, VA   24014-2325    USA