Membership Form

Connecticut Piecemakers Quilt Guild Registration Form

2008-2009

NAME_________________________________________________

(Please Print Clearly)

ADDRESS______________________________________________

CITY_____________________ STATE________ ZIP___________

PHONE___________________

BIRTHDAY (no year needed)__________

E-MAIL ADDRESS____________________________

___Please check here if you are renewing your membership and any of the above information has changed

        ___Renewal $25.00

        ___New Membership $25.00

        ___Alumnae $15.00 (mailings only)

        ___I will not be renewing my membership

**PLEASE SEND ONLY CHECKS, MADE PAYABLE TO:

“Connecticut Piecemakers Quilt Guild”

PLEASE RETURN THIS FORM & PAYMENT TO:

CT Piecemakers Quilt Guild, Membership Chairman, PO Box 35, Monroe, CT   06612-1926