Membership
Application for the
Louisa Chapter of the Daughters of the American
Revolution
THE UNDERSIGNED TWO (2) MEMBERS IN GOOD STANDING
OF THE LOUISA CHAPTER, NSDAR, HEREBY ENDORSE AND RECOMMEND FOR
MEMBERSHIPS IN SAID CHAPTER THE FOLLOWING:
NAME:
____________________________________________________________
ADDRESS:_________________________________________________________
___________________________________________________________
CITY: ___________________________________
STATE: ___________________
ZIP CODE: __________
TELEPHONE: (____)-____-_______________________
BIRTH DATE AND
PLACE:____________________________________________
ANCESTOR:
________________________________________________________
CHAPTER REFERRAL:
_______________________________________________
DATE PROPOSED INTO
CHAPTER:________/_______/_________
DATE ACCEPTED INTO CHAPTER:
________/_______/_________
SIGNED: _______________________________
NATIONAL #_________________
SIGNED: _______________________________
NATIONAL #_________________
DATE PAPERS SENT TO NATIONAL: ___/___/____
DATE PAPERS RECEIVED AT NATIONAL: ___/___/____
DATE APPROVED AT NATIONAL: ___/___/____
NATIONAL #_______________
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