National CGOA Membership Form - Print and Mail (Rev: 1/25/04)

YES, I would like to join the Crochet Guild of America and receive Member Benefits.

Or join/renew national CGOA dues online with a secure credit card transaction.

NAME: __________________________________________________________________

ADDRESS: ______________________________________________________________

CITY: ______________________________________ STATE: ______ ZIP: ___________

COUNTRY: _____________________

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

E-MAIL: _______________________________________________________________

Yes, I belong to a CGOA Chapter (name of chapter)______________________________

This information will be published in the Membership Directory only if you give permission:
_____ Yes, I give CGOA permission to publish my name, address, and e-mail in the Membership Directory in the Members-Only section on the website.
Signed ________________________________________ Date ___________________

_____ Yes, I give CGOA permission to publish my name and e-mail in the Membership Directory in the Members-Only section on the website.
Signed ________________________________________ Date ___________________

_____ Yes, I give CGOA permission to publish only my name in the Membership Directory in the Members-Only section on the website.
Signed ________________________________________ Date ___________________
 Enclosed is my annual Membership Fee: _____ New Member _____ Renewal

Individual Membership:
____$35.00 U.S.
____$42 Canada/Mexico
____$50 International

Business Membership:
____$125 Proprietor
____$1000 Corporate
&n bsp;I want to sign up for 2 years and save. Enclosed are dues for two years membership:

Individual Membership:
____$65.00 U.S.
____$79 Canada/Mexico
____$95 International

Business Membership:
____$245 Proprietor
____$1995 Corporate

Method of Payment: Please allow 4 to 6 weeks for processing. Thank you!
______I have enclosed a check or money order (U.S. funds only) payable to "Crochet Guild of America".
______Please bill my credit card: _____Visa _____MasterCard

 Credit Card #:                                
 Expiration Date:        

Signed _______________________________________________Date _________________
(signature required for credit card payment)

Mail your completed membership application form with payment to:
CGOA, PO Box 3388, Zanesville, OH 43702-3388

Or join/renew national CGOA dues online with a secure credit card transaction.