I, the undersigned, hereby apply for membership in the German- American Society of York- Alpenrose. The following information is submitted for consideration. (Please Print All):

Name______________________________________________________________________

Address____________________________________________________________________

City_____________________Zip Code_____________Tel. No. (_____)_________________ e-mail Address ____________________

Place of Employment_________________________________________________________

Do you speak German?_________Fleuntly__________Some___________None_________

Do you play an instrument?____________Sing?_____________Dance_________________

What are your interests, Hobbies, Artistic Talents, Musical Abilities? _________________

What do you expect to receive from the society?___________________________________

Were you a member previously?__________When?_________________________________

What Clubs or Societies are you now active in?____________________________________

I am a citizen of:______________________Recommended by:________________________

I will comply with the rules and regulations of the Society;

Signature______________________________________________  Date__________________

Make checks payable to ALPENROSE (Adult dues are $15.00 per person per year. Dues for youth 6 years old through college are $7.50)

Optional : Birthday I______________________Anniversary________________________

Birthday 2______________________E-Mail ___________________________

Officers Only:

Approved __________________________Approved_________________________________

Amount received $______________________ Membership No.______

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