Name:    

    
Date:

Address:

City:

State:

Zip:

Phone:

E-mail:

Please answer the following questions:

I give permission for the above information to be published in a roster booklet to be distributed only among members of the Gathering of Quilters Guild and will not be passed out to outside sources to be used for any type of solicitation.  
Yes
No

I prefer to receive the newsletter by regular mail.
I will print the newsletter from the website.

I give permission for my quilt to be photographed and published on the guild website.  
Yes*
No

*If answered yes, I understand it is my responsibility to inform the photographer if certain quilts may not be photographed.

Dues: $20
Cash
Check

Print and send completed form and payment to:

The Gathering of Quilters
PO Box 631
Sylvania, OH  43560