1. Which membership are you applying for? (Check One)

      Individual     Dual/Family  

2. Would you be interested in having a mentor? (Check One)

      Yes     No  

3. What would be the most convenient time for you for meetings? (Check One)

      Day     Evening     Saturday     No Preference  

Name: __________________________________________
Phone __________________________________________
Address: ________________________________________
City: ___________________________________________
State: __________________________________________
Zip Code: _______________________________________

Mail this form to:

Lakes Area Violet Growers Membership Application
Date mailed: _________ Check No. __________