Name: __________________________________________________________________
Address: _________________________________________________________________
City/State/Zip: ___________________________________________________________
Phone: __________________________________________________________________
E-mail: ___________________________________________________________________
Membership Dues: ($20 per household or business) $________________ enclosed
Special Gift: $ ___________________
Please make your check payable to "Friends of Rocheport Society"
Mail to: Friends of Rocheport Society How would you like to receive information from FOR?
P.O. Box 122 _____ E-mail
Rocheport, MO 65279 _____ U.S. Postal Service
