Great Lakes Region
The Embroiderer’s Guild of America, Inc,
Chapter Quarterly Membership Reporting Form

Chapter Name____________________________________________________

Amount Enclosed_________________________ Date____________________

(Dues are $1.00 per person)

Check the Quarter applicable:

1^st Quarter (Due April 15)__________ 2^nd Quarter (Due July 15)_________

3^rd Quarter (Due October 15)_______ 4^th Quarter (Due January 15)______

Note: the mailing dates are the same as for National dues.

Person responsible for sending Membership dues:

Name ___________________________________________________________

Address__________________________________________________________

________________________________________________________________

Telephone and email address_________________________________________

Mail this completed form along with a check made out to

Great Lakes Region EGA to the current treasurer

Form updated 3 May 2006