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:

David & Rita Youngblood
3515 Brushy Lane
 Charlotte N.C. 28270