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Jersey Firedevils
Southern New Jersey Local Chapter
ISGB Midatlantic Region


MEMBERSHIP INFO:
Name_____________________________________________________________
Address:___________________________________________________________
City______________________________________State_______Zip___________
Phone (_____) ______ - _______________
E-Mail____________________________________________________________
(We use e-mail to notifiy members of up and coming meetings and special events)


New Member ___ Renewing member ___
I am also a member of ________________________ Chapter


DUES:
Please indicate the type of membership (If you’re a student, include a photocopy of your current ID.):


Individual Membership $35.00 Individual and also a member of National $25.00 Student with active student ID $15.00


Please mail your completed form and your payment to the address below.

(Checks should be made out to Jersey Firedevils)


Jersey Firedevils
45 Evergreen Lane
Haddonfield, NJ 08033


Please tell us a little about yourself, your interests and goals in glass on the reverse side of this form. What do you wish to pursue? (i.e.: Lampworking, fusing, glassblowing, etc.)