Membership Application and Release Form

 
In consideration of membership in the Queen City Sampler Guild, I hereby voluntarily assume all risks of accident or damage to my person or property and hereby release and discharge the Queen City Sampler Guild from every claim, liability, or demand of any kind sustained relating to activities of the Guild.

Signature ______________________________________ Date: ____________________________

Membership: Active
or Associate
 

Name (please print)________________________________________________________________

 

Address_________________________________________________________________________

 

City, State, Zip_____________________________________________________________________

 

Birthday month/date (year optional) ____________________________________________________

 

Telephone number (include area code): Home___________________________________________

 

(Please circle the telephone number you prefer the Guild to use)
Work ______________________________ Cell__________________________________________

 

Email address____________________________________________________________________
(Provide the email address that you prefer to use for Guild’s business)

Put me on these stitch-in email lists: Daytime__________________Nighttime___________________

 

Interest Survey (How can you help your Guild?)

Chair a stitch-in group

Work on a fund raiser/holiday party
Help assemble/mail a newsletter
Work a shift at an exhibit/show
Write an article or book review for the newsletter
Lead a workshop or provide a program.
Topic: (Optional)____________________________________
Serve as an officer or chairperson of a committee Position/Committee _________________________________
Other: ____________________________________________

Mail to: Queen City Sampler Guild, P. O. Box 46562, Cincinnati, OH 45246-0562
 
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