Updated 4-11-07

This site maintained and designed by Bruce Corson, Preferred Rubber.

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Application

Wisconsin Rubber Group
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

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