QUINEBAUG VALLEY ENGINEERS ASSOCIATION, INC. - APPLICATION FOR MEMBERSHIP


DUES ARE $20.00/YR PER PERSON. PAYABLE WITH APPLICATION.

INCLUDES QVEA DUES AND INSURANCE.


NAME		______________________________________________

ADDRESS		______________________________________________

		______________________________________________

CITY		______________________________________________

STATE		______________		ZIP ____________ - ________

TELEPHONE	( ______ ) _______ - _____________

EMAIL		_______________________________________________

WEB PAGE	_______________________________________________

Make Checks Payable to: QVEA

Mail to: 	QVEA, 180 SOUTH PLUMB RD., MIDDLETOWN, CT 06457