Application for membership

Order of the Black Rose

Name : ___________________________________________

Address:__________________________________________

        __________________________________________

Phone : (____) ___________________________________

email: ___________________________________________

State Society :  Florida

OCRFS Chapter name : _____________________________

There are no membership dues for membership in the Black Rose. Pins are available for $ 15.00

___Application only ____ Pin only ____ Both Pin and  Application

Send application to : Sylvia Darby, 1st Vice President

                      Order of Confederate Rose

                      P.O. Box 303, Quincy, FL 32353

** For pin orders please make checks payable to Yvonne Brown and mail to

                    Suzy Hager  --- 

                    1033 Ashford Drive

                    Charlotte, NC 28214

                    704.393.2132        

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