Name:___________________________________________________________
Address :_________________________________________________________
_________________________________________________________
City:________________________ State:________ Zip
Code:______________
Phone: (
)____________________
E-mail : ___________________________________________________
Are you currently a member of The American Rose Society? Yes ____ No ____
Dues: _____ $15.00
(Make checks payable to: Connecticut Rose Society)
Send completed application and dues payment to:
Marina Wittig
c/o Connecticut Rose Society
18 Niederwefer Rd.
Broadbrook, CT 06016