Membership
Application/Renewal Form
DATE______________
CLUB NAME___________________________________________________________
CLUB ADDRESS________________________________________________________
NAME OF CONTACT PERSON_____________________________________________
CONTACT ADDRESS____________________________________________________
TELEPHONE DAYTIME_______________________ EVENING____________________
EMAIL ADDRESS________________________________________________________
OFFICE/POSITION CURRENTLY HELD_______________________________________
Payment of
annual dues
ANNUAL STATE DUES are due to be paid by August
31, 2011, for the 2011-2012 year.
Annual dues are
$2.50 per member. The JOINING FEE for a
If your club is
renewing its membership, and fails to do so by October 1, 2011, a $25.00 REJOINING FEE will be added to your dues.
PLEASE CHECK
1. Annual Renewal (oneTime)
______no fee
2. First time
application
______$10.00/club
3. Annual renewal
(delinquent)
______$25.00/club
Local member
dues:
The number of
members currently registered in our local club is _________ X $2.50 each.
TOTAL AMOUNT OF DUES_______________
PLEASE WRITE
CHECK FOR THE TOTAL AMOUNT DUE,
|
NC MOTHERS OF MULTIPLES |
Please mail
checks and this document to:
|
Katie McGuffin
|
NCMOMS will appreciate your club's efforts to pay dues on time.