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Membership Form Print E-mail
 

Lake Michigan Sampler Guild

 Please print:  
 Name:____________________________________________________

 Date:____________________

   Renewal Membership New Membership
 Please fill out the information below for both new memberships and renewals:

 Address:____________________________________________________

  ____________________________________________________

 CIty/State/Zip:____________________________________________________

 Home Phone:____________________________________________________

 Work Phone:____________________________________________________

 Email address:____________________________________________________

   
 May we publish your email address? Yes No

 Is this a change of address? Yes No

 How did you hear about LMSG?

 ____________________________________________________

  
  Annual Full Member Dues $30 Annual Associate Dues $15
(Discounted to $15 after June 1st)
 
Please make your check payable to Lake Michigan Sampler Guild.

Lake Michigan Sampler Guild's dues are due on January 1st of each year.

Mail this form and check to:

Susan Balsai
8132 Danneil Circle
Long Grove, IL 60047