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MEMBERSHIP FORM

Please fill out the form below and mail with check for $15.00 per person made out to MOVS to Mid Ohio Valley Shaggers, 1 Wireless Way, Suite 405, Parkersburg WV  26101 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?