Name: __________________________________________________________________
                         Given               Middle               Maiden                     Surname

Husband's Initials: ______________

Address: ________________________________________________________________
                                   Street                              City                           State             Zip

Phone: (___)_______________ Email: ________________________________________

Chapter and number: ______________________________________________________

Location: _______________________________________________________________

Name of Ancestor: ________________________________________________________

Service:_________________________________________________________________

Place of Burial:___________________________________________________________
                                      Cemetery                   City                County             State

Type of Marker:__________________________________________________________

Signature of Applicant: ___________________________________Date:_____________

Fees:
Original Membership application: $6.00
Yearly dues: $5.00 (Payable by Aug. 31 of each year to Treasurer, RGGC)
Supplementals: $4.00

Make checks payable to: Texas Division RGGC

Mail 3 copies of the completed application, (all with original signatures) and one copy (pages one and four) of the member's approved application on this ancestor (please do not send copy of certificate) to:

Mary Hall, Treasurer, TX Division RGGC
1291 Rockdale Rd.
Sulphur Springs, Texas 75482
Phone: (903) 885-7747
Email: myhall@cox-internet.com

Rev. 10/30/05