Polish Genealogical Society of Michigan
Registration Form

2017 Annual Seminar
When: Saturday, October 28, 2017, 9:00 am to 4:00 pm ~~ Registration Begins at 8:30 am ~~ Where:  American Polish Cultural Center, 2975 E. Maple Rd. (15 Mile Rd.) at Dequindre Rd., Troy, Michigan 48083 ~~ Included:  Four presentations, Speaker Handouts, Continental Breakfast, Polish Lunch, and door prizes.
  If you want your ancestral surnames and village locations included in the seminar syllabus fill out that portion of the form. 
Personal Information:
First Name:  Required
Last Name:  Required
Address:  Required
Address 2:
City:  Required
State / Province:  Required
Postal Code:  Required
Home Phone:  Formatted as (000) 000-0000
Cell Phone:  Formatted as (000) 000-0000
Email:  Required
Ancestral Information:
  If you would like to have your ancestral surnames and locations included in the Seminar syllabus, complete the sections below:
List Ancestral Surnames:
Enter all surnames followed by a comma.
List Ancestral Locations:
Enter all locations followed by a comma.
PGSM Related:
Is this your first PGSM Annual Seminar?: Yes   No
Please make a selection.
Are you a PGSM Member?: Yes   No
Please make a selection.

Security Code / Place Order:
Click the small checkbox below. You will receive a security code. Enter it into the "Required" field. Continue by clicking "Send Registration".
You will receive a "Thank You" notice with a PayPal button, allowing you to complete your checkout by paying your $65.00 seminar fee with a credit card of your choosing.
Check box & enter code:   Required