2023
CBQ Membership Renewal Form

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Name: ______________________________________________________

Any Changes to Your Information?  (Please Circle)   Yes    No

Membership Category:    (  )   Regular          $35.00

    
If you answered “No”  above – Stop Here

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Address: _________________________________________________________

City: ____________________________State: ___________Zip Code_________

Phone: __________________________Cell Phone: ________________________

E-Mail: _____________________________Birthday: Month/Day_____________

 

Membership by Mail
Send this renewal form and a check made out to CBQ to:
Terri Klancer

12930 Sleepy Creek Way, Apt 102

Woodbridge, VA 22192
(703-232-0186)
If you would like to have your membership card mailed to you, please enclose a stamped self-addressed envelope with your renewal form and check.