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.