Please note: The information you provide here is for the use of the CDSG membership only. It will appear in a CDSG membership directory. If you do not want your phone numbers published, mark those fields with a N (do not print).
Name: ___________________________________________________
Address: _________________________________________________
City: _________________________ State/Prov: __________________
Postal Code: ___________________ Country: ___________________
Indicate individual ____ or organizational ___ membership
Home Phone: _____________________________________ Y __ N __
Work Phone: ______________________________________ Y __ N __
Fax Phone: ________________________________________ Y __ N __
Email: _________________________________________________________
Membership Statement: I, the undersigned, agree to abide by the By-Laws of the CDSG, Inc. Failure to sign and date the below may be cause to be denied membership in the CDSG. Copies of the By-Laws are available upon request from the Memberhsip Chairman.
Signature: _____________________________ Date: ________________________
For CDSG use only: member number: _______ Date Joined: _________
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