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RRQG Membership Form
Our membership year begins April 1, 2021 (no fooling!) and ends March 31, 2022. Dues are $30.
Please fill out all the information for your membership chairs.
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Email
*
Your email
Type of Membership
*
Renew
New
Last Name
*
Your answer
First Name
*
Your answer
Preferred Name
Your answer
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Home Phone Number
*
Your answer
Cell Phone Number
*
Your answer
For the phone number, please note which one you prefer people to use to contact you by typing an asterisk (*) after the preferred number.
Month and Day of Birthday (The year field is required, but you can put any year you want. We will not use the year in our records.)
*
MM
/
DD
/
YYYY
Are you 80 years or older?
*
Yes
No
If you are 80 years old or older, your membership is reduced to $15.
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