Payment by:
Check
VISA
MasterCard
Money Order

Credit Card # ______________________________________

Signature __________________________________________

Exp. Date _____________  3-digit Security Code ___________

Please enroll me in the following category of support for the Swenson Swedish Immigration Research Center:

Swenson Center Associate (annual contribution of $30 or $_____ )
Swedish American Genealogist (one-year subscription for $28)
Swenson Center Associate and one-year subscription to Swedish American Genealogist
         (total annual contribution of $45 or $_____ )
Swenson Center Scholar (annual contribution of $100 or $_____ )
Swenson Center Circle (annual contribution of $250 or $_____ )
Swenson Center Sustaining Contributor (annual contribution of $500 or $_____)
Other Amount $_____
Please send me information on endowment possibilities.

Name: _____________________________________________________________________

Street: _____________________________________________________________________

City: _____________________ State: _____ Zip+4: _________________-_______________

Telephone (_______) _______ - ____________

Email: _____________________________________________________________________