Ladies of the Lakes Quilt Guild

Membership for Nov. 1, 2011 through Oct. 31, 2012

Please print clearly & double-check all information

Circle one: New Renewal

Name: ______________________________________________Birthday (month/date) _______________

Residential Address: ____________________________________________________________________

Mailing Address: _______________________________________________________________________

Phone: _______________________ Email: __________________________________________________

Winter Address: ______________________________________Winter Phone: ______________________

I prefer to receive the newsletter by US Postal delivery: _______ Email delivery: ______

I prefer to provide refreshments during the month of: _____________________________

I wish to be included in the “Inclement Weather Meeting Cancellation Call List” Yes: ___ No: ___

Membership fee (annual) $20.00: _______

Guild Pin fee: $2.50: ________

Total: $_____________

Mail form and check (payable to LLQG) to: Anne Marie Tranfa

PO Box 306

Melvin Village, NH 03850