Great Lakes Lace Group, Inc.

Membership Application

Check one: New______ Renewal______

Check one: Full _____ Household_____ Junior_____

Date:______________________________

Name:___________________________________________

Address:_________________________________________

City/State/Country:_____________________________________________ Zip code +4:____________ - ___________

E-mail address:_________________________________

Phone (with area code):(_______) ________________

May we list your phone number (circle one): Yes_____ No_____

I verify that the ZIP CODE listed is correct for my address/city (please initial here):_________

I am especially interested in:

Making Lace ________ Type(s)_____________________

Collecting Lace ________ Type(s)_____________________

Studying Lace ________ Type(s)_____________________

Member Classifications:
Full (all privileges) - Regular Fee
Household (Same Address) - 1/2 Regular
Junior (Up to 16 years) - No fee

Dues per year:
US = \$20.00
Canada & Mexico = \$24.00 (US funds only)
Overseas = \$30.00 (US funds only)

Please specify to which membership year(s) you wish your payment applied: _________________

Make Checks Payable To:
GREAT LAKES LACE GROUP INC.

Signature _________________________________________________

Send to:
Pam Kirk
GLLGI Membership Chair
P.O Box 522
Brooklyn, Mi 49230-0522