Please print clearly or type. Use the correct uppercase or lower case letter where applicable.

Renewal_____ New Member_____ Information Change_____
Membership Year: September 1, _____ through August 31, _____

Name: ________________________________________________________________________

Address: ______________________________________________________________________

City: _____________________________________ State: ______ Zip Code: ________________

Home Phone: ________________ Work Phone: ________________ Cell Phone: ______________

E-mail: ________________________________________________________________________

Basket Business name, if applicable: __________________________________________________

Basket Business web site, if applicable: http://____________________________________________

Please indicate preferred method to receive The Twining Times newsletter:   Email___   or   Mail___

Dues are $20 per year and not refundable or prorated. A $5.00 late fee is charged for membership
renewal after December 1st. Please make check payable to MBG and contact for mailing
address.