2011 2012 CVQG Membership

Print this form and hand it and payment (Cash or Check made out to CVQG) to the Membership Chair (Marty DelNevo) at a meeting, or mail them to her at 172 Village Grove, Williston, VT 05495. Questions: E-mail or call Marty at msundbyvt@comcast.net or 802-878-7457.

Date / MM / DD YYYY
Name First Last
New Member Renewing
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone - (###) - ### ####
Email
Membership Fee - $20.00 $ . Dollars Cents
Add Tax-deductible contribution to CVQG
Payment Cash Check