Member Year 2023-24 Year Joined Application *INDICATES REQUIRED INFORMATION First Name * Last Name * Email Address * This will be your login user name Password * Please enter a password (up to 10 characters). Confirm Password * Confirm Password BirthdayMonth JanFebMarAprMayJunJulAugSepOctNovDec BirthdayDay 12345678910111213141516171819202122232425262728293031 Dates inFlorida (e,g, Year Round, Jan-Apr, etc.) Contact Information Local Street Address Local City Local State AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Local Zip Code Home Phone Number Cell Phone Number Alternate Contact Information If you have an alternate address, please check the box below. I have an alternate address Alternate Street Address Alternate City Alternate State/Province ABAKALARAZBCCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMBMDMEMIMNMOMSMTNBNCNDNENHNJNLNMNSNTNU NVNYOHOKONORPAPEQC RISCSDSK TNTXUTVAVTWAWIWVWYYT Alternate Postal Code Alternate Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongoCosta RicaCôte d‘IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceFrench GuianaFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Interests: I would like to learn how to: Nationally known or local quilters I would like to hear include: Workshops I would like to attend (list subject, idea or interest): Please check office, committee or guild activity where you may be willing to help: Audit Budget Community Service Historian Hospitality Membership Member-led Workshops Monthly Projects Gathering Stitches Newsletter Programs Public Relations Quilt Show Travel Workshops Check All That Apply Special Skills/Areas of Expertise Computer Artwork Photography OtherOther Name Name First First Last Last Phone Name Name First First Last Last If you are human, leave this field blank. Δ
