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Name_____________________________________________ Phone (___)___________ Address_________________________________________________________________ City_______________________________________ State ________ Zip ____________ E-mail Address_____________________________________________________ Regular Membership (Between ages 18-64) $25.00 ½ year 12.50 Note: ½ year membership fee is only for new members joining after Jan.1, 2008. Cannot be used for renewel. Make checks payable to C.O.Q.G. Are you a member of NQA? Yes_____ No_____ Would you be willing to accept an office for the following year? |
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*President |
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*Director of Library *Denotes Board Member Position |
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