Capital City Quilter’s Guild

PO Box 35036, Juneau, Alaska 99803-5036

Membership 2011/2012 Application/Renewal form: 

YOU MUST PRINT & MAIL THIS FORM!

The membership year is September 1^st through August 30^th.

                                     Annual Dues $35.00; make checks payable to CCQ.

Please Mark                                                                                   For CCQ Treasurer                                    

New Member:  ___________                                                       Check Number:  ________

Renewal:        ____________                                                        Date:_________________

Returning Member: ________                                                          Cash payment:_________

LastName:_______________________FirstName:____________________MI:______

Mailing Address:_________________________________________________________

City:______________________________________________State:_____Zip:________

      Home phone:______________________________ Work phone:___________________

       E-Mail:  __________________________________  Birth Month: _______________

      Mark your preference for delivery of the Newsletter:  ____EMAIL ___hardcopy

      Please check if you are interested in helping with any of the committees      ______

      Please check the Committee you would be interested in helping.

     Comments, ideas, or suggestions:

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