Guild Membership form

Guild Membership Form

Complete the form below to sign up for your membership.
Full Name*

First NameLast Name
Membership Type*

NewRenewing
Home Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
The monthly newsletter will be distributed by e-mail only.
Preferred Email Address*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact: In the event of an emergency, who should we contact?

First NameLast Name
Relationship of emergency contact to you
Emergency contact phone number
Please enter a valid phone number.
Permission for publication. The Wiltwyck Quilters Guild occasionally wants to publish pictures of our speakers, guild members, and quilts on our website and/or Facebook page. By checking the line below you are indicating that you are NOT allowing us to publish you or your works.

I do NOT want my image or my works published
Acceptance*

I have read, understand and accept the requirements for membership
Please send your check for $35.00 payable to Wiltwyck Quilters Guild.
Mail to: Shirley Swenson, 402 Slate Quarry Road, Rhinebeck, NY 12572
Enclose a self-addressed, stamped envelope if you would like your membership card mailed to you.
Should be Empty:

Guild Membership Form