CHARLOTTE ROSE SOCIETY

MEMBERSHIP APPLICATION

 

Mr.  Mrs.  Ms.  Name _________________________________  Spouse ________________

 

Address _____________________________________________ City ______________________

 

State __­­­­­­­________________   ZIP _  _  _  _  _  -  _  _  _  _   Phone (_  _  _) __________________

 

Email Address ______________________________________________

 

Charlotte Rose Society Membership (Single or Family)  - - - - - - - - -  $15.00 per year __________

                           

Optional:

American Rose Society Membership - - - - - - - - - - - - - - - - - - - - - - $49.00 per year _________<

                                If age 65 or older - - - - - - - - - - - - - - - - - - - - - - $46.00 per year _________

Carolina District Bulletin Subscription - - - - - - - - - - - - -          - - - - - - - -  $10.00 per year  ________

                                                                                                           

                                                                                                                        Total _________

Make check payable to "CHARLOTTE ROSE SOCIETY" and mail to:

Michael Icenhour  

4319 Wordsworth Ln.                        micenhour@mema.net

Charlotte, NC 28211