Date: __________________

NAME: ___________________________________

ADDRESS: ________________________________

__________________________________________

PHONE: (_____)______________________

EMAIL: _______________________________

BIRTHDAY: (Month, day -- NOT year!) _________________

NEEDLEWORK INTEREST(S) (Please underline or circle)

Crochet Clothing Construction Color/Design Counted Thread Dolls/Teddy Bears French Hand Sewing History Knitting other: __________

Lace, Needleweaving Miniatures Macrame Machine Knitting Machine Stitchery Needlepoint Quilting Rug Braiding .

Smocking Soft Sculpture Silk and Metal Silk Ribbon Surface Stitchery Stumpwork Weaving Teaching .

Please write your check for $10.00 for one year's dues payable to
SOUTH HILLS TEXTILE ARTS GUILD.