Membership Form

The AQSG membership year is November 1 through October 31. New memberships received on or after August 1 will continue through October 31 of the following year.

Contact Information

New Membership Renewal Gift Membership
First Name:
Last Name:
Street Address 1:
Street Address 2:
City:
State or Province:
Country :	USA Canada Other
If Other Country:
Postal Code/Zip Code:
Phone:
Email Address:
Website:
Gift From:
Referred By:

Membership Level

To Make a Donation

Fund		Amount
	Type only numbers and decimal points into the boxes.
	Dime a Day	$
	Endowment Fund	$
	Cuesta Benberry Keynote Fund	$
	Lucy Hilty Research Fund	$
	Publications Fund	$
	Seminar Scholarship Fund	$
	Unrestricted Donation	$

How to Receive Publications

Blanket Statements is sent to members by e-mail unless you choose to receive a paper version by mail.

I would like to receive my Blanket Statements via mail	Yes	No
I would like to receive my February Directory via mail Cost $10	Yes	No

Quilt-Related Interests

The following information will be listed with your name in the Directory. Please check all that apply.

	Student	$55
	(Send copy of current Student ID card)
	Senior (age 65 and over)	$55
	Friend	$65
	Associate	$110
	Guild/Organization	$110
	Benefactor	$250 - $999
	Sponsor	$1000 - $1999
	Patron	$2000 - $4999
	Pacesetter	$5000 - $9999
	Master's Circle	$10,000 and above
	If you chose Benefactor, Sponsor, Patron, Pacesetter or Master's Circle, please enter the amount of your membership below. Only enter numbers. No dollar signs ($) or commas.
	Amount: $
	Extra postage for international members: Canada: please add $8.00 for postage. All other countries please add $25 for postage

	Appraiser	Historian
	Author	Industry
	Collector	Museum
	Dealer	Quilt Maker
	Designer	Quilt Restoration/ Conservation
	Educator	Research
	Folklorist	Women's Studies
	Other
If "Other" was selected, please indicate what your interest is:

American Quilt Study Group

Membership Form