MEMBERSHIP APPLICATION FOR CENTRAL FLORIDA CHAPTER

Name:  _____________________________ 

Street Address:  ________________________________________________

_____________________________________________________________
                   City                                              State             Zip

Phone:  (Home)  ___________________________ 
             (Work) ___________________________________

E-Mail Address:  _______________________________________________

___________  Primary Membership ($53.00)

____________ Plural Membership  ($18.00 within Sun Region)

____________ Plural Membership ($21.00 outside Sun Region)
Primary Chapter   ________________________________ 
National #:   ________________________

Birthday _______/______
               Month       Day

Needlework Interests:
________________________________________________________________________

Circle Needlework status:  
Beginner         Intermediate       Advanced      Teacher        Designer         Shop owner