WVQ Membership Application

	Homepage Membership Page
Membership Application	Please Mark Check Boxes with an X.

Membership Application

Please Mark Check Boxes with an X.

Dues are $15.00 for each calendar year and can be paid for 1 or 2 years.
After CAREFULLY typing in your information, please PRINT this form and MAIL with your dues check to:
Marilee Bright, Membership Secretary
480 White Oak Estates Road, Sutton, WV 26601-9561 Thanks!
• Make your check or money order payable to “West Virginia Quilters, Inc.”

For Office Use Only
Exp.	M.O./Check #

Amt. Rec’d	Date

Individual Membership	1 Year	2 Years	Dues: $
Would you like to include a tax-deductible donation to support WVQ programs?			Donation: $

Date

Check / M.O. #

Total Amount Enclosed: $

Name		WV County	Zipcode
Home Phone	Cell (optional)

Address

City

State

E-Mail Address	Can you satisfactorily receive newsletters via e-mail?	Yes
		No

Are you a member of NQA?		WV Guild Memberships
Yes	Membership Number
No

Do you wish to share your quilting skills with others in our membership directory? (Mark with X's.)
Teacher	NQA Teacher	Hand Quilter	Long Arm Quilter
Domestic Machine Quilter	Collector	Speaker	Judge
NQA Certified Judge	AQS Certified Appraiser	Design/Sell Patterns	Sell Quilted Items
Other

Do you own a quilt shop?

Yes

Other quilt-related business?

Yes

Please describe goods or services offered

Business Name

Website

Address (if different from above)

City

State

E-Mail Address

Phone

Zipcode

If No Storefront:	Internet Sales:			Phone/Mail:			By Appointment:
	Yes	No		Yes	No		Yes	No