NAME  _____________________________________________________________________________
               Given                             Middle                         Maiden                                 Surname

HUSBAND’S INITIALS  ________   HOME TELEPHONE  (_________)__________________________

ADDRESS  _________________________________________________________________________
                      Street                                       City                                State                     Zip+4

E-MAIL  _______________________________   FAX  (_________)_____________________________

CHAPTER  ____________________________#__________  LOCATION  _______________________

NAME OF ANCESTOR  _______________________________________________________________

SERVICE  __________________________________________________________________________

PLACE OF BURIAL  __________________________________________________________________
                                      Cemetery                         City                         County                           State

TYPE OF MARKER  __________________________________________________________________

I certify that the above information is true and correct, that the applicant is a member in good standing of the chapter named above, and that the applicant is the real great-great-granddaughter of the soldier documented herein.

CHAPTER REGISTRAR ________________________________________________________________
                                                  Signature                                                      Date

APPLICANT  ________________________________________________________________________
                                                  Signature                                                      Date

Please make three (3) copies of the completed RGGGDC application.  Chapter Registrar will please sign all three and retain one completed, signed copy for Chapter records.  Send original and one copy of the application with a check in the amount of $4.00 (payable to “Texas Division RGGGDC”) to:

Shirley Buehler
1007 League Road
Lewisville, Texas 79049-4463
972-221-6169
srbuehler@hotmail.com

Initial dues with application are $4.00.  Thereafter, annual dues of $3.00 are to be paid by August 1 of each year to RGGGDC TX Division Treasurer.  Dues may be paid at Texas Division Convention by club members or by chapter chairmen for the new year.  Please include a SASE for a membership card.