Ringerike - Drammen Districts Lag Membership

Family Origin Information
Membership Application for Ringerike - Drammen Districts Lag Dues are $10.00 per year or $25.00 for 3 years. Please print this form, fill out and rmail to address below
Name			Date
Renewing Member [ ] <-- Check one --> New Member[ ]
Primary Address		start and end dates
Street			Phone
City			Email
State and Zip Code
Secondary Address		start and end dates
Street			Phone
City			Email
State and Zip Code
.
Family origin in RDD 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



Family origin in RDD 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 the ancestor information w/your name and email on our website? Yes___ No___
Mail with check payable to Ringerike - Drammen Districts Lag to Tom Robinson, 891 Raindale Circle, Grand Forks, ND 58201