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Membership Application

Note: Please print out the application and fill in by hand.
Please write within the solid lines. THANKS

ROSIE THE RIVETER ASSOCIATION

MEMBERSHIP APPLICATION

(Please reproduce for each applicant)

Membership Type (check one)

___Rosie: Working woman of World War II

___Rosebud: Female descendant of a Rosie

___Rivet: Male relative; date of meeting _______.

 

PLEASE PRINT IN CAPITAL LETTERS

Circle one:  Mrs.  Mr.   Miss   Ms.   Dr.

Name____________________________________

             First         Maiden              Last

Address__________________________________

                 Street, RFD, or Box                  Apt. No.

_______________________________________

 City                              State                  Zip

Telephone (____) ______-___________

Email:____________________________________

Type of work or volunteer work done by Rosie.

If applicant is a Rosebud or Rivet, give type of work
done by your Rosie (mother, wife, etc.)

_______________________________________

_______________________________________

_______________________________________

Approximate dates of work:________________

Location of Work:________________________

 

Rosebuds: Print complete name of your Rosie:

_______________________________________

Your relationship to Rosie: __Daughter; __Granddaughter; __Great Granddaughter.

Is your Rosie living? __Yes __No

Member of ARRA? __Yes __No

 

Rivets: Print complete name of your Rosie or Rosebud_________________________________

 

Rosies and Rosebuds only: Enclose check for $10 made to ARRA and mail with application to:
Mrs. Mabel W. Myrick, Treasurer
P.O. Box 188
Kimberly, AL 35091

 

(Your certificate is your receipt)

Revised January 1, 2007

ROSIE THE RIVETER ASSOCIATION

MEMBERSHIP APPLICATION

(Please reproduce for each applicant)

Membership Type (check one)

___Rosie: Working woman of World War II

___Rosebud: Female descendant of a Rosie

___Rivet: Male relative; date of meeting _______.

 

PLEASE PRINT IN CAPITAL LETTERS

Circle one:  Mrs.  Mr.   Miss   Ms.   Dr.


Name____________________________________

             First         Maiden              Last

Address__________________________________

                 Street, RFD, or Box                  Apt. No.

_______________________________________

 City                              State                  Zip

Telephone (____) ______-___________

Email:____________________________________

Type of work or volunteer work done by Rosie.

If applicant is a Rosebud or Rivet, give type of work
done by your Rosie (mother, wife, etc.)

_______________________________________

_______________________________________

_______________________________________

Approximate dates of work:________________

Location of Work:________________________

 

Rosebuds: Print complete name of your Rosie:

_______________________________________

Your relationship to Rosie: __Daughter; __Grand-daughter; __Great Granddaughter.

Is your Rosie living? __Yes __No

Member of ARRA? __Yes __No

 

Rivets: Print complete name of your Rosie or Rosebud_________________________________

 

Rosies and Rosebuds only: Enclose check for $10 made to ARRA and mail with application to:
Mrs. Mabel W. Myrick, Treasurer
P.O. Box 188
Kimberly, AL 35091

 

(Your certificate is your receipt)

Revised January 1, 2007

Please cut this application in half along middle line.