irish patchwork society Membership Application Form Surname:

First Name:

FULL postal address:

Telephone:

Mobile:

 New member

 Renewal

Email: Year of first joining IPS

Please indicate which branch(es) you attend:  Eastern Branch  Mid Western Branch  North Eastern Branch

 Southern Branch  Western Branch  South Eastern Branch  South-Western Branch  South Midlands Branch

 None

 International Member.

The Irish Patchwork Society is a voluntary body and depends on members support; please tick if you are willing to support the IPS by helping with:  Branch meetings  Committee work  Photocopying  Workshops

 Branch demonstrations  Exhibitions  Local transport  Other

 Typing/Computer  Teaching  Publicity

Membership Rates:  Ireland €40  Family €60  Student €20  International €60 I enclose a cheque/postal order/bankers draft made payable to “The Irish Patchwork Society” for membership from September to September . Please renew at your Branch at the September meeting. If you do not attend a branch meeting, please send this completed form to: The Membership Secretary, The Irish Patchwork Society, P.O. Box 45, Blackrock, Co. Dublin, Ireland. Areas of interest (please tick as many as are applicable).  Hand Quilting  Appliqué

Signed:

 Machine Quilting  Traditional Design  Fabric Dyeing/Painting  Art Quilts  Exhibiting  New techniques/Workshops

Dated: