Member Guild Membership Form

Guild Name*

Mailing Address*

City, State, Zip*

Website URL

Website email contact

Facebook Information

Instagram Information

Guild meets: Day and Time*

Guild meeting address:*

Guild officers change (month):*

President*

President Phone No. (for emergency only):

President E-mail Address:*

Program Chair*

Program Chair E-mail address:*

Newsletter Editor*

Newsletter Editor E-mail address:*

SCCQG Representative*

SCCQG Rep E-mail address:*

Treasurer*

Treasurer E-mail Address:*

Is Guild opting in to participate in the SCCQG liability insurance policy? Select yes or no.*

Please indicate number of members in the guild.*

Insurance premium due for Member Guilds only (multiply number of members by $4.00 per person)

2022-23 Annual Guild Dues at $40 per Member Guild OR $65 after Nov. 30*

Did you include 2022-23 annual venue renewal Cert. fee ($10) - select yes or no*

Total Submitted (only one check req.):*

Check No.:*

Date Check Mailed to Treasurer, SCCQG, 2329 Boone Ave., Venice, CA 90291*

Name of Person Completing this Form:*

Email address:*

2022-23 SCCQG Membership Form - Member Guilds