Your membership is valid for a period of two years from the date that your
application is processed. To join or renew your membership, please print this page,
fill it out and mail it along with your check directly to:
Bill Quill, 2441 Sabado St., Las Vegas, NV 89121
THIS IS A NEW ____ OR RENEWAL ____ APPLICATION DATE: _____________
NAME: ______________________________________
ADDRESS1: ______________________________________
ADDRESS2: ______________________________________
CITY:________________________, STATE: ____ ZIPCODE:________________
TELEPHONE NUMBER: ______________________________
EMAIL ADDRESS: ___________________________________
YOUR FIBER INTERESTS:_______________________________________________________
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MEMBERSHIP TYPE, PLEASE SELECT ONE:
Single membership ____ $20.00 Family membership ____ $40.00
Friend of IWC ____ $50.00 Patron of IWC ____ $100.00
Would you care to add any comments. Feel free to use both sides of the
form. Its your paper and your conference.
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