Order of the Confederate Rose

Application

Date___________                                                                        Life _____  Regular ______

Name______________________________________________Date of Birth___________________

 Street Address____________________________________________________________________

City/State/Zip code_________________________________________________________________

Area Code/Phone #_________________________________________________________________

Local Son of Confederate Veterans Affiliation___________________________________________

Email address_____________________________________________________________________

 * Recommendation ________________________________________________________________

Reason for becoming a member__________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Your Signature________________________________________________________________________

*Your recommendation must be a current OCR member or SCV member

Note: If you do not know an OCR or SCV member to recommend you, please leave that line blank. Please complete and return  to the address below with your check or money order for dues. ($20.00 for 1 year or $150.00 for a life time membership) payable to Order of the Confederate Rose.

Mail dues and application to: Lisa Morgan, 603 Shadeville Road, Crawfordville, FL  32327

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