Embroiderers' Guild of America, Inc.
Quarterly Report of Membership Dues

Complete this form, then print and send for payment.

Enter Today's date :       (mm/dd/yy)  

From:     Chapter:
To:   Pam Burke,   
        Sun Region Treasurer
        118 Dana Pointe,
        Niceville, FL   32578
        Tel:   850-678-0657

Quarter Ending:First Quarter (January 1 through March 31)
Check OneSecond Quarter (April 1 though June 30)
Third Quarter (July 1 through September 30)
Fourth Quarter (October 1 through December 31)
Number of NEW members this quarter
Number of RENEWING members this quarter
Number of Out of State - PLURAL - members this quarter  (do not count plural members whose home chapter is in the Sun Region)
TOTAL members this quarter
Amount Due:  Total Members x $3.00
Make check payable to SUN REGION EGA
Name:  
(Membership Chairman)
Address:
     
CityST           ZIP
Phone Number:  
This form should be prepared and sent to the Sun Region Treasurer no later than the 15th day of the month following the quarter's end.

If no dues are paid for the quarters, complete the form showing $0.00.

Please use this form to duplicate additional copies for your supply.

Thank you for your cooperation.  Timely reporting will ensure the accuracy and coordination of chapter and Region records.
For Treasurer's use only Date received:________________

Posted: ______________________		 Math checked: ________________
Date Deposited: _______________
Amount: ______________________

Revised: Mar. 13, 2006
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