Saline County Quilt Guild

2012 Membership Form

Membership Dues for 2012 are $15

1. Name __________________________________________________________

(Current guild members – Only fill in the line or lines below if

your information has changed from last years roster)

2. Address _______________________________________________________

3. City/State/Zip _________________________________________________

4. E-Mail Address ________________________________________________

5. Home Phone w/Area Code ____________________________________

6. Cell Phone w/Area Code ______________________________________

7. Month and Day of Birth _______________________________________

8. Year you joined SCQG ________________________________________

9. Are you a Lifetime Member ? Yes or No (Circle one) ** Lifetime members are those that have maintained their membership with this guild for a minimum of 10 years, and had their 75^th birthday before January 1, 2012.

New members who join during October, November or December will be members for the rest of 2011 and all of 2012. Members may start renewing for 2012 in November.

The new roster will be distributed after the February guild meeting.