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PLEASE PRINT
Piecemakers of Elmira Membership Application Form
Membership Year 2023-2024
Date ________________Rejoin: _____New Member: _______
Name: _____________________________________Phone #________________
Address: ____________________________________City: ___________________
State__________ Zip: __________
Winter Address: _________________________________________________
Dates @ Winter address From: _________To:_____________
E-Mail: _______________________________________________________
All newsletters will be sent via e-mail.
Month and Day of Birth: ______________________________-
I would be interested in sharing my talents or skills with a demonstration and/or instruction at our meeting about : __________________________________________________________
This could be extended to a workshop on the subject after lunch.
I would be interested in serving on the Board (list position) ___________________
I would be interested in serving on an existing committee: ____________________
Membership is $25/year before Oct 31th. After Oct 31th you will be charged a late fee of $5 per month. Exception any person joining the first time after Feb 1 will pay $10.
Bring to completed membership document to meeting or mail to
Penny Correll
306 W Lenox Ave
Elmira, NY 14903
Received by Membership Chair _____________________________Date:_________
Given to Treasurer: _________________________Initials: _____Date:_________
Revised 07/01/23 Card: _________
Piecemakers of Elmira Membership Application Form
Membership Year 2023-2024
Date ________________Rejoin: _____New Member: _______
Name: _____________________________________Phone #________________
Address: ____________________________________City: ___________________
State__________ Zip: __________
Winter Address: _________________________________________________
Dates @ Winter address From: _________To:_____________
E-Mail: _______________________________________________________
All newsletters will be sent via e-mail.
Month and Day of Birth: ______________________________-
I would be interested in sharing my talents or skills with a demonstration and/or instruction at our meeting about : __________________________________________________________
This could be extended to a workshop on the subject after lunch.
I would be interested in serving on the Board (list position) ___________________
I would be interested in serving on an existing committee: ____________________
Membership is $25/year before Oct 31th. After Oct 31th you will be charged a late fee of $5 per month. Exception any person joining the first time after Feb 1 will pay $10.
Bring to completed membership document to meeting or mail to
Penny Correll
306 W Lenox Ave
Elmira, NY 14903
Received by Membership Chair _____________________________Date:_________
Given to Treasurer: _________________________Initials: _____Date:_________
Revised 07/01/23 Card: _________