Membership Application for
LINCOLN COUNTY GRAPE GROWERS ASSOCIATION

 

Name:________________________________________________________________________
 

Address:______________________________________________________________________

City:______________________________
State:_____________
Zip:_________________
 

Phone: (Primary)

______________________________________ 

  

Phone: (Secondary)

_______________________________________
 

E-mail:________________________________

  

Web Site:______________________________
 

Name of Venture: ______________________________________________________________

Membership Category: (circle one)

Regular 1 yr. $60.00    or    6 mos. $30.00

Select Membership Type: (circle one)

 Grower     or     Winery

 

Mail completed form with appropriate dues made payable to LCGGA to:


LCGGA
P.O. Box 33
Sparks, OK 74869