Chapter Name_____________________________________ Check One
Chapter Number ___________
100% _____
New _____
City _____________________________________________
Renewal _____
Date________________________________________ Expiration Date__________________________
Chapter Contact Person _________________________________________________________________
Address _________________________________________________ Phone (_____)______-_________
City _________________________________________________ Zip Code+4_____________________
Use one form for renewals and one from for new subscriptions.
Make all checks payable to "TREASURER GENERAL UDC"
Name ___________________________________
Name __________________________________
Address _________________________________
Address ________________________________
City/State/Zip ____________________________
City/State/Zip ____________________________
Name ___________________________________
Name __________________________________
Address _________________________________
Address ________________________________
City/State/Zip ____________________________
City/State/Zip ____________________________
Name ___________________________________
Name __________________________________
Address _________________________________
Address ________________________________
City/State/Zip ____________________________
City/State/Zip ____________________________
Name ___________________________________
Name __________________________________
Address _________________________________
Address ________________________________
City/State/Zip ____________________________
City/State/Zip ____________________________
Name ___________________________________
Name __________________________________
Address _________________________________
Address ________________________________
City/State/Zip ____________________________
City/State/Zip ____________________________
New rates as of January 1, 2005 1 year - $15.00 2 year
- $25.00 3 year - $35.00
Send two (2) copies of each subscription form plus check to the
Texas Division Magazine Chairman
Ms. Betty Mann
410 Trail View Way
Friendswood, Texas 77546