Title: M/M, Mr. Mrs. Ms. Dr. _______________
Name: (Last)_____________________(First)_______________________(Middle)_______________
First Name of Spouse: ______________________
Street and Number:________________________________________
City______________________________________________________
Zip Code:_______________________________
Telephone Number:_______________________________
E-Mail Address:__________________________
(Your e-mail address is requested only for purposes of receiving e-mail about the DRS and will not be sold or shared with anyone for any other purpose.)
Detroit Rose Society annual family dues are $16.00. (One or more members of the same household). Please make your check payable to the Detroit Rose Society and mail with this printed application to:
Detroit Rose Society
P.O. Box 225
Dearborn Heights, MI 48127
DRS Form 03/01