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Proposed Application Review Form

     Print the form, fill it out (please print), and send it with a self addressed, stamped BUSINESS size envelope to the
Society of Mayflower Descendants, Joan Pekowsky, Historian, 1629 North Golf Glen #D, Madison, WI 53704
$125.00 application fee to be included with the form, below.

Date  Phone:  
Name:  
Address:  
E-Mail Address:  
 1. Name of your Mayflower Pilgrim Ancestor: 
 2. Son/Daughter: Married: 
 3. Son/Daughter: Married: 
 4. Son/Daughter: Married: 
 5. Son/Daughter: Married: 
 6. Son/Daughter: Married: 
 7. Son/Daughter: Married: 
 8. Son/Daughter: Married: 
 9. Son/Daughter: Married: 
10. Son/Daughter: Married: 
11. Son/Daughter: Married: 
12. Son/Daughter: Married: 
13. Son/Daughter: Married: 
14. Son/Daughter: Married: 
15. Son/Daughter: Married: 

Your name should be last.                                                                                                                                                   

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