�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 _____________

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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� __________

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                                                                                                                                                             Total _________

 

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

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