MEMBERSHIP / DONATION FORM

  Tennessee Viticultural & Oenological Society

                        ____  Membership (New) - $20

                        ____  Membership (Renewal) - $20

                        ____  Harry & Lora Westcott Education Scholarship Fund
                                                (Please indicate amount below)

              Name _________________________________________________               

             Phone (        ) ___________________________________________

             Address: Street __________________________________________

            City & State __________________________ Zip Code __________

            Amount: $ ___________________________

Make check payable to:

Tennessee Viticultural & Oenological Society (T.V.O.S.)

Return to:   LINDA BURNETTE, Treasurer
PO Box 156
Sequatchie, TN 37374