PALMETTO GOURD PATCH
MEMERSHIP APPLICATION FORM
Name (please print)
Address
..
City
Zip Code
..
Tel: Home:
Work or Cell:
Email address:
Enclose check or money order for $15.00 *MEMBERSHIP RUNS FROM JULY 1 EACH YEAR
Please complete the above form and bring to the next meeting or forward it, together with your check or money order to:
Treasurer
Iris Durrand
444 Cheulah Rd.
Brevard, NC 28712