GEORGIA FUNERAL SUPPLY SALESMEN�S ASSOCIATION

							       GEORGIA FUNERAL SUPPLY SALESMEN’S ASSOCIATION
                        Patty S. Hutcheson, Secretary
                                 P.O. Box 681
                            Buchanan, GA 30113

           APPLICATION/DUES NOTICE FOR MEMBERSHIP
                    YEAR ________         DUES: $35.00

YOUR NAME: ________________________________________________________

MAILING ADDRESS: __________________________________________________

CITY ____________________ STATE_____ ZIP _________ BIRTHDAY_______

YOUR COMPANY NAME: ______________________________________________

HOME PHONE: _______________________ BUSINESS _____________________

E-MAIL ADDRESS: ___________________________________________________

        PLEASE ADVISE OF ANY CHANGES OR CORRECTIONS.

              THANK YOU FOR YOUR SUPPORT OF GFSSA




       GEORGIA FUNERAL SUPPLY SALESMEN’S ASSOCIATION
                        Patty S. Hutcheson, Secretary
                                 P.O. Box 681
                            Buchanan, GA 30113

           APPLICATION/DUES NOTICE FOR MEMBERSHIP
                    YEAR ________         DUES: $35.00

YOUR NAME: ________________________________________________________

MAILING ADDRESS: __________________________________________________

CITY ____________________ STATE_____ ZIP _________ BIRTHDAY_______

YOUR COMPANY NAME: ______________________________________________

HOME PHONE: _______________________ BUSINESS _____________________

E-MAIL ADDRESS: ___________________________________________________

        PLEASE ADVISE OF ANY CHANGES OR CORRECTIONS.

              THANK YOU FOR YOUR SUPPORT OF GFSSA