|
 Betty Pfiester, Treasurer c/o Rhein Chemie Corporation 13133 Longwood Ave. Burton, OH 44021 440-285-3547
MEMBERSHIP APPLICATION
Please print this form from your browser and sen it to the address above with check or money order, for twelve ($12.00) dollars for one year's paid MEMBERSHIP, to the WISCONSIN RUBBER GROUP.
NAME______________________________________________________________________________
Company Name______________________________________________________________________
Company Address ____________________________________________________________
City____________________________________State_________Zipcode_______
Company Phone ___________________________ Ext __________ FAX ________________________
Your Title _______________________________________________________________
Home Address ___________________________________________________________
City____________________________________State_________Zipcode_______
Home Phone ____________________________ Fax ______________________________
Email Address ___________________________________________________________
|
Mailing Preference:
|
Home (_____)
|
Business (_____)
|
|
ACS Member (_____)
|
Div Member (_____)
|
|
Would you work on a Committee:
|
Education
|
(_____)
|
|
Scholarship
|
(_____)
|
|
|
Winter Fest
|
(_____)
|
|
Golf Outing
|
(_____)
|
|
|
Membership
|
(_____)
|
|
|
|
|
WRG Membership Officer
|
Below - Membership Officer use only:
|
|
Date Paid: ___________
|
Check Number: ___________
|
New Member
|
Back to Home Page
|