CVBG Membership Application

Mail to:

George Smart
2705 Buckhorn Hills
Maidens, VA  23102

 

Membership Application

Date _______________Phone ___________________________________________

Name _____________________

Email Address: ___________________________

Address _____________________________________________________________

City___________________________________State ____  Zip ___________

Occupation _____________________

Spouse's Name ________________Spouse's Interests _____________________

My Interests/Hobbies:_________________________________________________

Would you like your news letter e-mailed ? Yes / No

Annual Dues: $20.00

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