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Please print off this form, complete it, and mail it with your check payable to: Columbia Gorge Polymer Clay Guild

Membership Application / Renewal Form
Membership Dues for 2003 (January 1 to December 31)
__ New Member	__ Renewal
__Individual $25	__ Senior (over 55) $15	__ Student (under 21) $15
Please make check payable to CGPCG and mail to: K & L Frantz, Membership 7720 SW Wilson Ave Beaverton, OR 97008

Please PRINT legibly:

Name:

Address:

City/State/ZIP:

Phone: (                 )

e-mail:

Web site address: http://

CGPCG support. If you can help out in any way with CGPCG activities, please indicate your interests and skills here. Checking these boxes will not commit you to anything.
□ mailings	□ newsletter preparation	□ writing & editing	□ guild shows	□ program planning	□ publicity and/or community outreach	□ special committee leader or member	Other:

Serve on the Board of Directors as:
□ President	□ Secretary	□ Treasurer	□ VP Membership	□ VP Programs	□ Librarian	□ Webministrator	□ Newsletter Editor

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