State Association Name: ___________________

Date State Instituted _______________________

Colors you prefer : ________________

Style: _________________________

(Floral, American, Victorian, Angels, Animals, Etc)

This Space may be used for a Photo of State President.

Our State Association Supports the Following Charities:

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Fund Raisers in Our State Association include:

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Name: ________________________________

Address: ______________________________

City: _______________ State: _____ Zip:_____

Phone No: ____________________________

E-mail Address: _________________________