<p> United Daughters of the Confederacy® Great-Great Granddaughters Club Membership Application North Carolina Division Please print or type</p><p>Applicant’s Full Name:</p><p>Address:</p><p>City State Zip Code + 4</p><p>(Area Code) Phone Number E-mail Address</p><p>Chapter Name & Number: City:</p><p>UDC Original Application or Supplemental Date Accepted: (The application that your Great-Great Grandfather is your ancestor.) Please enclose a copy of UDC membership certificate.</p><p>Name of Great-Great Grandfather: Service Record</p><p>Company: Regiment: State: </p><p>Signature of Applicant: Date:</p><p>Signature of Chapter Registrar: Date: (Certifying that the forgoing information is true and accurate to the best of your knowledge thus making the named applicant eligible for the GGGD Club of North Carolina Division and General.)</p><p>Signature of GGGD Club Treasurer: Date: (Accepted by Division)</p><p>Application into the Club will be $10.00 (includes 1st years dues and Certificate.) Make checks payable to: NC Division Great-Great Granddaughter’s Club (NC Div. GGGD’s Club). This form should be filled out in triplicate with all original signatures. One copy remains with the Chapter Registrar. Two copies are sent to the Club Treasurer – Caroline Mazzeo, 408 Sportsman Trail, Wendell, NC 27591-7490</p><p>Revised August 2016</p>