MEMBERSHIP / DONATION FORM

 Tennessee Viticultural & Oenological Society

                        ____  Membership (New) - $35

                        ____  Membership (Renewal) - $35

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

           Name _________________________________________________

             Phone (        ) ___________________________________________

             Address: Street __________________________________________

            City & State __________________________ Zip Code __________

            Amount: $ ___________________________

 Email Address ___________________________________________

Make check payable to:

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

Return to:   CARRIE JOHNSON, Treasurer
114 Masters Rd.
Hilman, TN 38568