Associate MEMBERSHIP APPLICATION

Highlight below from "I wish" through the end of the application and then print that selection.

I wish to be an Associate Member of the New York State Grange and help sustain the work of the
Grange. As an Associate Member I understand that I am entitled to the member services of the
Grange.  A brochure outlining these services will be sent upon receipt of this application. Also,
as an Associate Member of the Grange, I understand that I am "without vote" in the local Grange
until I choose to become an initiated member of a local Grange.  If you are
not aware of a local Grange we will include contact information with your member brochure.

(Please Print)
Name_______________________________Phone_______________E-Mail______________

 Address__________________________City______________State_______Zip Code_______

LOCAL GRANGE AFFILIATION (if you choose to be affiliated with a local Grange,
that Grange will receive $10 of your dues and be credited with your membership.

I wish to have a local Grange affiliation?______ Yes _____No 

If you know the name of the Grange you wish to affiliate with enter below:

GRANGE NAME___________________ GRANGE NUMBER._________ COUNTY_________

DATE__________SIGNATURE___________________________________________________