Membership Application
AMERICAN GOURD SOCIETY, INC
P.O. Box 2186
KOKOMO, INDIANA 46904-2186
New____     Renewal____     Date___________

Please Print:

NAME _________________________________________________________________
 

STREET ________________________________________________________________
 

STREET 2 _______________________________________________________________
 

STREET 3 _______________________________________________________________
 

CITY___________________________________________________________________
 

STATE __________________ ZIP ________________COUNTRY___________________
 

Email:__________________________________________________________

***SNOWBIRDS -- more than one address??? -- please read

PHONE (________) _________ - ________________
 

COUNTY___________________________________

  Your membership information will only be used for official AGS business.
 
 

Dues ( U. S.): $20.00 one year;        Canadian Dues:  $30.00 one year        Dues Outside North America: $45 one year 

Mail Dues to above address