Member of National Garden Clubs, Inc.

Mail to 1st Vice President Suzanne Potts, 9114 Cinnebar Dr. Indianapolis, IN 46268-1241

 Phone
                  Last Name    First Name     Middle Initial

ADDRESS
                    (Street)                     (City)                      (State)                     (Zip)

DISTRICT   CLUB NAME 

State Life Member    National Life Member   Flower Show Judge          
Landscape Design Consultant   Gardening Consultant   Environmental Consultant 
OFFICES HELD - PAST AND PRESENT:  (Include year if known)

CLUB:

DISTRICT:

 REGIONAL:

NATIONAL:

Are you interested and willing to serve on the:
State Board YesNo Regional Board YesNoNational Board Yes No

What are your special interests or talents?

What are your hobbies? 

DATE COMPLETED: Signature 

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