ESSO Grotto
Eastern States Speleological Organization, Inc.
Membership Application Form
Date: ________________
Name: _____________________________
Mailing Address: _____________________________________________
City/State/Zip: ______________________________________________
Email Address:________________________________________________
Telephone Contact Number: ____________________________________
Membership Dues:
Individual Member (Voting) $15 a year
Family Dependent (Non Voting) $5 per dependent / per year
Family Dependent Name: _______________________________________
Family Dependent Name: _______________________________________
Family Dependent Name: _______________________________________
Family Dependent Name: _______________________________________
Dues Expire on January 1st of Each Year
Make checks Payable to ESSO Grotto
Mail Completed Form and Payment to:
ESSO Grotto
c/o Sheila Gilliam
211 Woodland CT
Grayson, Kentucky 41143-8001