New Member Application

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Please complete this form and return with payment to:

Penn Rose Quilt Guild 

Attn: Lois Prytherch

51 N Greenwood Ave.

Easton, Pa 18045

Name_______________________________________________

Address_____________________________________________

E- Mail Address______________________________­­­________

Home Phone _____________   Cell Phone __________________

Dues Payment - $35.00 + $10.00 New member fee = $45.00

(payable to Penn Rose Quilt Guild)

For use by PRQG 1st VP:

Check # _________     Cash Payment: _____________

Date RCVD:  __________   Date to Treasurer:  __________