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Membership Form
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* User your browser Print button to print this page.
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Family _____ Individual _____
Name: _________________________________________________
Address: ________________________________________________
Phone: ______________________
E-mail: ___________________________________________
Please check one of the following:
Current Member _____ New Member _____
If you are a new member, were you referred by a current Raleigh Rose Society member?
Yes _____ No _____
If so, by whom? _____________________________________
Membership dues are $15 per family or individual.
Please print and mail this form with payment to:
Kathy Nicoll
Email Knicoll@nc.rr.com
100 Midden Way
Holly Springs, NC 27540
Phone: (919) 341-1027
If you have any questions about your membership status, please
call any of the officers and we will check into it for you.
For Treasurer's Use Only: Dues Paid? _________ Date: ____________
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