APPLICATION FOR MEMBERSHIP
CENTRAL COMMUNITY SUBORDINATE GRANGE

Name:  ___________________________________________

Street: ____________________________________________

City: ______________________      State: ______   Zip: ______

Phone #: __________    E-mail: ________________________

Occupation: ______________________  Date of Birth: ________

I hereby apply for membership in Central Community Subordinate Grange #22. I desire to unite with others in elevating and advancing the interest of the American Family and community life, receiving in turn the benefits and advantages of those who belong to the Grange. I promise a faithful compliance with the By-laws of this Grange and the Constitution and By-laws of the State and National Granges. I have not previously applied for membership in this or any other Grange during the past six months. I understand that the annual dues are currently $32.00 and a one time application fee of $3.00.

Signature of Applicant: ______________________ Date: _________________

Application should be mailed to:
Secretary Central Community Grange
Debbie Goodrich
2 Duffy Road
Boylston, MA 01505