YEARLY DUES: $20

Print out this application form and mail
to the address below with annual dues of $20 (US).

Name

Badge Name

Spouse Name

Mailing Address

City/State/Zip/Country

Telephone

E-mail address

Rotary Club

District

MAIL TO:
UNITED STATES GOLFING FELLOWSHIP OF ROTARIANS
c/o Millie MacKenzie,
P. O. Box 3074
Sunriver, OR 97707-0074
macknz@chamberscable.com