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MEMBERSHIP FORM

Please fill out the form below and mail with check for $20.00 per person made out to MOVS to Mid Ohio Valley Shaggers, P.O. Box 2623, Parkersburg WV  26102 or email form by pressing submit button.

  1. Please provide the following contact information:

    New Member  Renewal

    Name
    Title
    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Country
    Work Phone
    Home Phone
    E-mail

  2. Choose a committee to serve on from the following options:

    Hospitality
    Social
    Food
    Decorating
    Newsletter
    Communications

  3. Birthday:

    Month Day

  4. Select any of the following options that apply:

    Yes  No   Do you wish to receive e-mails?