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Membership Form

New England Shutterbugs Camera Club

Membership Application 

2017 -2018

Name (Please Print): ___________________________________________

Address:                 ________________________________________________

City/State/ZIP: ________________________________________________

E-Mail Address: ________________________________________________

Home Phone:                     __________________ Cell Phone: __________________

Annual Membership Fee:  $45.00 for Individual - ($25.00 after January 1st)

                                        $60.00 for Family - ($40.00 after January 1st)

Please make check payable to:   NEShutterbugs

Mailing address:                     Susan Sanderson

                                                848 Northfield Road

                  Lunenburg, MA 01462

Payment method:
                    Cash:  [   ]          Check:  [   ]

What's in your camera bag?
Camera you use:      
Canon [  ]  Fuji [  ]  Nikon [  ]  Pentax [  ]   Sony [  ]  Other [  ]

Please Note:

If there is a need to cancel a meeting due to inclement weather members will be informed via an e-mail.  If you do not have an e-mail address or if you want to be notified by another means please fill in the contact information below.

Home Telephone Number:    ___________________________________________

Other (Please be specific):      ___________________________________________

I have read and agree to abide by the Constitution and By-Laws of the New England Shutterbugs.

Signed by:    ______________________________________    Date: _________________

Received by: _____________________________________     Date: _________________

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