Name:

Address:

City:                       State:          Zip:

Phone                               Cell:

Email:

Are you working?

Work Phone:

Birthday                          Anniversary

Interests:

Hobbies:

Favorite Color:

Favorite Flower:

Send this completed form, Along with your $15.00 for Membership to Suzy Mulbey, 22013 NE Floral Avenue, Aurora, OR 97002.  Make all checks or money orders out to Suzy Mulbey.