APPLICATION FOR MEMBERSHIP IN 
AFRICAN VIOLET SOCIETY OF AMERICA, INC. 

MR. WARREN E. J. GOTTSHALL, Treasurer 
AFRICAN VIOLET SOCIETY OF AMERICA, INC. Date 
P. O. Box 901 
Alexandria, Virginia. 
Please enroll me as a member of African Violet Society of America, Inc. 
My dues for a twelve month period are enclosed. 

~Recommended by Signed__ 
F Street Address 
City and State 




CHECK CLASS OF MEMBERSHIP DESIRED 
[.] Individual Membership for Twelve Month Period ... .... ... -.- 2. --- ---- $3 
[[] Sustaining (Commercial) Membership for Twelve Month Period .... .... $10 
Make Checks Payable to African Violet Society of America. Inc. 
See Reverse Side 
