Membership Form - Florida Gourd Society
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1Florida Gourd Society, Inc.
Membership Form
st
Florida Gourd Society, Inc. annual dues are $12.00. The membership year is from January through December and due January 1
. Quarterly
newsletters will be sent via email. Please print, fill out this form and mail it along with your payment to Therese Zamoiiski.
Name: ___________________________________________________________________________
Therese Zamoiiski
Address: _________________________________________________________________________
Membership Chairman
18501 Rock Knoll Dr.
City/State/Zip: ____________________________________________________________________
Jacksonville, FL
32221-6552
Email: ______________________________________________ Phone: (_____) _______________
(904) 783-6054
Patch affiliation: ______________________________________ Date: _______________________
_
Do you have a seasonal address?
Which months will you be at this address? ______________________________________________
__
Make checks payable to:
Please give membership this information so your newsletter will not be interrupted.
Florida Gourd Society, Inc.
Address: _________________________________________________________________________
□
□
New___________
Renewal __________
City/State/Zip: ____________________________________________________________________
□
Change _____________
Email: ________________________________________________ Phone: (_____) _____________
Please notify membership of any changes using this form so your contact information will be
current and you will receive the newsletters.
Revised January 2012
Florida Gourd Society, Inc.
Membership Form
st
Florida Gourd Society, Inc. annual dues are $12.00. The membership year is from January through December and due January 1
. Quarterly
newsletters will be sent via email. Please print, fill out this form and mail it along with your payment to Therese Zamoiiski.
Therese Zamoiiski
Membership Chairman
8501 Rock Knoll Dr.
Jacksonville, FL
32221-6552
(904) 783-6054
Make checks payable to:
Florida Gourd Society, Inc.
□
□
New
Renewal
□
Change
Revised January 2012
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