Deaf Seniors of Georgia

Join

DSG Membership Form

Date

Name *

First

Last

Date of Birth

Status

Spouse Name (if he/she is included for membership)

First

Last

Date of Birth (Spouse)

Wedding Anniversary Date:

Address

City/State/Zip

Email:

VP:

Do you prefer to receive DSG Newsletter through Email or mail?

Make check payable to DSG (NOT to Debra Barnick) Send check and membership form to: Membership Chair Debra Barnick 9515 Kraft Dr. Winston, GA 30187

Message

DSG is a 501(c)3 charitable organization.

All Donations are tax deductible.