Maltese Historical Society Submission of New Information

Maltese Historical Society Application for membership:

Membership in the MHS is open to anyone who has an interest in Maltese history and emigration and is willing to contribute to the mission of the Maltese Historical Society

PLEASE PRINT

NAME: (Last)____________________________

(First) _________________________________

(Middle)_____________________________

ADDRESS: ____________________________________

CITY:___________________________________________

STATE: ___ ZIP: ____________

TEL. NUMBER: ____________________________

E-MAIL: ________________________________________

DATE OF BIRTH: _____________________________

PLACE OF BIRTH: ______________________________

ARE YOU MARRIED? Yes No

IF YES, WIFE'S NAME: _______________________

What is your interest in the Maltese Historical Society? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Applicant' s Signature: ________________

Date: ________________

Please print out and return to Dr. Charles Vella