Taylor County Photography Club

PO Box 613, Grafton, WV26354-0613

Membership Application and Dues Renewal Form

Annual Dues (January through December) is $15.00 for an individual or for a family living at the same address.

Name:____________________________________________________________

Address:__________________________________________________________

City, State and Zip Code: ___________________________________________

Home Phone: _____________________ Work Phone: ____________________

E-Mail Address: ___________________________________________________

Date: __________________________ Amount Paid: _____________________

(Print and fill out this page and mail it to the above address with your dues payment.)