An American Rose Society Affiliated Organization

Organized April 21, 1947

Membership Form

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Family ______ Individual ______

Name: _________________________________________________

Address: ________________________________________________

Phone: ______________________

E-mail: ___________________________________________

Please check one of the following: Current Member ____ New Member ______

If you are a new member, were you referred by a current Raleigh Rose Society member?

Yes _____ No _____ If so, by whom? _____________________________________

Membership dues are $15 per family or individual. Please print and mail this form with payment to:

Kathy Nicoll

100 Midden Way
Holly Springs, NC 27540

Phone: (919) 341-1027

If you have any questions about your membership status, please call any of the officers and we will check into it for you.

For Treasurer's Use Only: Dues Paid? _________ Date: ____________