PSLG On-Line Membership Application
Simply print
this page, Complete the
required information,
and bring
completed form, along with your dues to our next meeting.
For further information contact John Eisenbart,
4739 Greenwood St, Skokie, IL 60076,
phone 847 679-4729, e-mail rxjohne@msn.com
DATE:_________________4739 Greenwood St, Skokie, IL 60076,
phone 847 679-4729, e-mail rxjohne@msn.com
NAME:
_________________________________________ E-Mail:
______________________
(first) (last)
ADDRESS:_________________________________________ Phone: (_____)________________
(Street number ) (Area Code)
_________________________________________
(City) (State) (Zip Code)
Area(s) of interest in leathercraft:
__________________________________________________________
__________________________________________________________
How did you hear about PSLG?: ________________________________________
Be sure to include dues with application:
Check Appropriate Spaces: Total:
_____ • Individual Membership - $18.00 (Inside U.S.) $_____________
_____ • Individual Membership - $21.00 (Outside U.S.) $_____________
_____ • Family Membership - $28.00 (Husband & Wife) $_____________
_____ • Junior Membership - $8.00 (Age 15 and younger) $_____________
_____ • Initiation Fee - $2.00 (Required for new members) $_____________
_____ • E-Mail Discount - $3.00 $(-___________)
(subtract from total if you wish to recieve monthly newsletter via e-mail)
TOTAL DUES ENCLOSED: $_____________
Thank you for your interest in the Prairie States Leather Guild.
The participation of interested people like yourself is what makes our Guild a great organization.
We look forward to seeing you at our meeting.
For guild use: Membership no.____________
(first) (last)
ADDRESS:_________________________________________ Phone: (_____)________________
(Street number ) (Area Code)
_________________________________________
(City) (State) (Zip Code)
Area(s) of interest in leathercraft:
__________________________________________________________
__________________________________________________________
How did you hear about PSLG?: ________________________________________
Be sure to include dues with application:
Check Appropriate Spaces: Total:
_____ • Individual Membership - $18.00 (Inside U.S.) $_____________
_____ • Individual Membership - $21.00 (Outside U.S.) $_____________
_____ • Family Membership - $28.00 (Husband & Wife) $_____________
_____ • Junior Membership - $8.00 (Age 15 and younger) $_____________
_____ • Initiation Fee - $2.00 (Required for new members) $_____________
_____ • E-Mail Discount - $3.00 $(-___________)
(subtract from total if you wish to recieve monthly newsletter via e-mail)
TOTAL DUES ENCLOSED: $_____________
Thank you for your interest in the Prairie States Leather Guild.
The participation of interested people like yourself is what makes our Guild a great organization.
We look forward to seeing you at our meeting.
For guild use: Membership no.____________