Indiana Gourd Society
New Patch Request Form

Name of person making request: 
Date of request: 

Information about person who will act as Patch Leader:
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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