--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
CGRS Membership & Name Badge Application Form
Name ______________________________ E-Mail ___________________
Address _____________________________________ Date ___________
City/State/Zip+4 _____________________________ Phone ___ ___ ____
Names for Badges ______________________ & ______________________
Total enclosed $____________ Check should be made out to "CGRS"
Mail this application and payment to:
Robert Collins
924 Middlebury Dr.
Worthington, Oh 43085-3466