Houston Polymer Clay Guild
MEMBERSHIP FORM
Member Information (check membership type)
____New _____Individual $25 per year
____Renewing _____Family $35 per year (please name
family members)
Full
Name:______________________________________________________
Street
Address:___________________________________________________
City___________________________
State:_______________ Zip:_________
Phone
(Home or Cell):_____________________________________________
E-mail
address:___________________________________________________
Website
Address (URL)____________________________________________
How
did you hear about HPCG?______________________________________
Referred
by:______________________________________________________
Membership Directory (check all that
apply)
HPCG
may publish a membership directory for distribution
to members only. Please specify what information you want included:
____Name ____Address ____Phone # ____E-mail ____Website URL
____Do not publish my information
Volunteer Information (check
all that apply)
Please
let us know if you would like to help in any of the
following areas.
Serve
on the Board as:
____ President ____Vice President ____Treasurer
____ Secretary ____ Membership ____Education
____ Publicity _____Member-at-large
Serve as:
_____Librarian ____Webmaster
_____Conduct a “clay along” tutorial during a meeting
_____Help
with Retreat planning/organizing
Other___________________________________________________________
Payment Information (check method of
payment)
______Check
payable to Houston Polymer Clay Guild
(Mail
to R. Hurley, 5203 Highway 3, Dickinson, TX 77539)
______PayPal
_______Credit Card via PayPal
Signature_________________________________________Date_____________
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