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First name*

Last name*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Email

Phone*

I am a new or returning member:*

New

Returning

Name given above is a:*

Primary ($20)

Secondary ($5)

Additional Primary ($20)

Name

Additional Primary ($20)

Name

Additional Secondary ($5)

Name

Additional Secondary ($5)

Name

Additional Secondary ($5)

Name

Additional Secondary ($5)

Name

Additional Secondary ($5)

Name

Additional Secondary ($5)

Name

I would like to receive my membership info by:*

Please mail ($8)

Pick up at Farmers Flea Market (Free)

Pick up at the next event (Free)

Pick up at the next membership meeting (Free)

Payment is made by:*

Credit Card via square website

Membership Form

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