Membership Form

MEMBERSHIP FORM CITRUS BELT QUILTERS
PO BOX 7489, REDLANDS, CA 92375

Please enter information EXACTLY as you wish your information printed in the directory.

NAME: FIRST NAME: LAST NAME: BIRTHDAY (Month/Day)

PHONE: *include area code please*

E-MAIL ADDRESS:

May we e-mail your NewsPatcher Newsletter? Yes No

ADDRESS:

MAILILG ADDRESS (if different than street address):

EMERGENCY CONTACT: Name Phone:

NEW/RENEWING (Choose one)
$35.00 Membership ($17.50 if joining after November 1)
CHARTER MEMBER -EXEMPT FROM PAYING DUES

$10.00 CHATELAINE Name:

Complete this form, print it, make check payable to CBQ. Bring to the next meeting
or mail to the address shown above. Dues must be received by April 30 to guarantee
that your name will be in the CBQ Directory.
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For Membership Use Only:

CASH $ ___________

CHECK # __________ Amount $ ___________ Dated ______________

Membership Card Issues Yes _________

Chatelaine Order? Yes _______ Paid ________ Received ____________________