Heritage Rose Foundation membership form
Membership in the Foundation is open to any individual or organization that is in sympathy with its purposes and goals. Members receive the Foundation's journal, Rosa Mundi, published three times a year. The Foundation is taxexempt under section 501(c)(3) of the Internal Revenue Code and contributions to it are tax-deductible.  Mail to: Heritage Rose Foundation, P.O. Box 1719 ,Gonzales, LA. 70707
Annual Dues:	U.S	Canada Mexico	Other Countries
Organization Individual/Family Senior/Family (Over 65) Student (Under 21)	$35 $25 $20 $20	$35 $27 $22 $22	$40 $30 $25 $25
Name:_______________________________________________________________________ Address:_______________________________________________________________________ City, State, Zip:_______________________________________________________________________ Country: _______________________________________________________________________ Telephone:_______________________________________________________________________ E-mail:_______________________________________________________________________ Please check here if this is a renewal NOTE: Members outside the U.S. should pay with a bank draft or personal check payable in U.S. funds and drawn on a U.S. bank. Make all checks payable to:  Heritage Rose Foundation
Or pay by credit card: Exact name on front of card:______________________________________________________________ Card type (circle one):  Visa     Master Card     American Express    Expiration Date: ___________________ Card number: _________________________________________________________________________ 3 digit security code on back (on front for American Express): ___________ Signature: ____________________________________________ Date: ___________________________
I wish to make a tax-deductible donation of _________ to the Heritage Rose Foundation.  revised 2008-04-04