Membership Form

Northern Illinois Chapter

Crochet Guild of America

NAME: __________________________________________________________________

ADDRESS: ______________________________________________________________

CITY: ______________________________________ STATE: ______ ZIP: ___________

PHONE DAY: (_______) ______________PHONE EVE: (_______) _______________

E-MAIL: _______________________________________________________________

______ Check this line if you do NOT want to be listed in the chapter membership directory.

______ Check this line if you WOULD LIKE to receive your meeting reminders via E-mail.

Northern Illinois Chapter Membership dues are $15 annually. Please pay by cash or check* to:

Devona Murrell
504 Maple Dr
Streamwood, IL 60107

*Make check payable to "CGOA-NIC".

Your first meeting is free with a fee of $3 per meeting required for the next two meetings. Thereafter, Northern Illinois Chapter membership is required to be obtained within the next six months. Fees may be paid at the meetings or by mail.

Signed _______________________________________________Date _________________