| CRVC-EGA Plural
 Membership
 
			  $15. Plural Membership   (NER
			  chapter)
 $18. Plural Membership
 (not NER chapter)
 $18. LIFE EGA Primary
 ($15 CRVC dues
 $3 NER dues)
 $15. LIFE EGA Plural
 (NER
			  chapter)
 $18. LIFE EGA Plural
 (not NER chapter)
 
			  Amt. Pd. ____________to CRVC-EGA
 
			  Date Pd. ____________(keep as your receipt)
 | CRVC-EGA Plural Membership and LIFE EGA Membership Form 
			  Use this form ONLY if you are a Plural Member of CRVC-EGA (new
			  or renewal)or a LIFE Member of EGA (with CRVC as primary chapter or as a plural
			  member)
 
			  Which membership category applies to you (select and indicate only
			  one)?
			   
			    
			      I belong to another chapter in the New England Region (NER). I'm new
			      to CRVC-EGA or renewing my CRVC EGA membership as a plural member. 
			      Dues = $15.
			    
			      I belong to a different region (not NER). I want to join CRVC-EGA
			      or renew my CRVC-EGA membership as a plural member.  Dues = $18.
			    
			      I'm a LIFE EGA member and want to establish or renew my CRVC-EGA
			      membership with CRVC as my primary chapter.  Dues = $18.
			    
			      I'm a LIFE EGA member and want to establish or renew my CRVC-EGA
			      membership as a plural member -- my primary chapter is in the New England
			      Region.  Dues = $15.
			    
			      I'm a LIFE EGA member and want establish or to renew my CRVC-EGA
			      membership as a plural member -- my primary chapter is in a different
			      region (not NER).Dues = $18.
 
			   Mail your completed form with a check payable to CRVC-EGA
			  to:Linda Berry, CRVC-EGA Membership, 343 Seabury Drive, Bloomfield, CT
			  06002.
 
			   Name:            
			  ____________________________________________________
			   
			   Address:        
			  ____________________________________________________
			   
			   City, ST,
			  ZIP  ____________________________________________________
			   
			   Home Phone: _______________________
			   
			   Cell Phone:    _______________________
			   
			   Email:          
			   ____________________________________________________
			   
			   Primary Chapter:
			  _________________________________________________
			   
			   Membership No. _______________________ |