HOUSTON GRAMPIAN ASSOCIATION
A HOUSTON / ABERDEEN SISTER CITY ORGANIZATION FOUNDED IN 1979

MEMBERSHIP APPLICATION

INDIVIDUAL/COUPLE

Name_______________________________________________________________________________

Address_____________________________________________________________________________

Telephone_________________Fax_________________E-Mail__________________________________

CORPORATE(Includes Public companies & Sponsors-3 MEMBERS ALLOWED) LIST WORK ADDRESSES

Company____________________________________________________________________________

Address_____________________________________________________________________________

Principal Member____________________________Title_______________________________________

Telephone_________________Fax________________E-Mail___________________________________

Second Member_____________________________Title_______________________________________

Telephone__________________Fax________________E-Mail___________________________________

Third Member______________________________Title________________________________________

Telephone_________________Fax_________________E-Mail___________________________________

Company Description____________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________


Date________________________      _____________________________________________________
                                                                                                Member's Signature

Dues:    Individual $30; Couple $50; Corporate $150; Public Company $200; Corporate Sponsor $500

    Make Check Payable To:         Houston Grampian Association
    Mail to:
              Tom Gossett CPAPC, Treasurer
              10700 Richmond Ave. Suite 219
              Houston, TX 77042
              Fax: (713) 974-2210

NOTE:We are a 501(c)(3) Corporation,therefore dues or contributions are tax deductible to the extent allowable by the IRS.