BORDER
CITY SQUARES
2009-2010 MEMBERSHIP
FORM
June 1, 2009 –
May 31, 2010
The rate structure is
designed so a single form may accommodate each family
unit.
| First Family
Member |
($20.00) |
Name:____________________________ |
$
20.00 |
| Second Family
Member |
($15.00) |
Name:____________________________ |
______ |
| Child (17 and
under) |
($10.00) |
Name:____________________________ |
______ |
| (* if in addition to a paid adult
membership) |
|
| Additional Family
Members at No Charge |
($0.00) |
Name:____________________________ |
No
charge |
| |
|
TOTAL |
______ |
| Address:
_______________________________________ |
| City:
_______________ State: _______ Zip:________ |
| Telephone:
_____________________ Publish telephone? Yes ___
No ___ |
| E-Mail:
________________________________ |
| Send Newsletter to the above E-Mail
address? Yes ___ No ___ |
| Best Way to
Contact You: Phone ___________ E-Mail _________ |
| |
| FOR TREASURER USE ONLY |
| Payment Received:
$ ____________ |
| Date: _____________ Cash $
__________ Check# ____________ |
Payment of your 2009-2010
dues would be appreciated before June 30, 2009.
Return form and payment during any Monday workshop,
or you may mail to:
Border City Squares
PO Box 998
Nashua, NH 03061-0998
|
