Indiana Gourd Society
New Patch Request Form

Name of person making request:
Date of request:

Information about person who will act as Patch Leader:
Name:
Address:
City/State/Zip:
Phone number:
E-mail address:

County where patch is located:
Nearest town:

Major Gourd Interest: Growing      Crafting      Both      Other
Number of persons showing interest in patch: 

What support can IGS provide for your new patch?

Do you think this will help with new IGS members in this area? How?

Send this completed form to:

Karen Niemeyer, president Indiana Gourd Society, Inc. 1217 Wesley Ct.. Thorntown, IN 46071

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