Name(s)____________________________________________ 

                        Address___________________________ Phone_____________ 

                        City_____________________ State_______ Zip_____________ 
                                                                                                      [nine digits] 
                        Email_______________________________________________ 
 

            I enclose the payment type as indicated below for membership in Gowen Research 
             Foundation. 
 . 
                                                        [ ]  New Membership 
                                                        [ ]  Renewal Membership 

                                       Payment type: 
                                               $15   [ ]  Member 
                                               $25   [ ] Contributing Member 
                                              $100  [ ] Sustaining Member
 

                             [ ]   Please send me a sample copy of the Foundation Newsletter 
                                    to the family researcher(s) listed on the sheet attached.