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Local Membership Renewal Name: _______________________________________________________________________ Business Name: _______________________________________________________________ Address: ________________________________________ City and Zip: ________________ Home Phone: _____________________________ Business Phone: ____________________ Fax#: _____________________________________Cell Phone: ________________________ Email address: _______________________________________________________________ Web address: _________________________________________________________________ IDS NATIONAL MEMBERSHIP #: ______________________________________________ Membership Level (Circle one) Professional Associate Affiliate Trade Store---------------------* Annual Fee: $60.00 Student ------------------------------------------------------------------------------* Annual Fee: $35.00 Member Directory All local members who are in compliance with IDS Northern California Wine Country Chapter standards, with their dues and application information updated by January 30th , will be listed in the member directory on the IDS Wine Country Chapter Website; www.idswinecountry.com unless expressly stated otherwise . The above information will be used to keep your membership listing current. Please notify our membership coordinator if there are any changes to your business listing throughout the year. Please be sure to fill out the following section and let us know if want to be a part of our member directory at no additional charge. The following information will be listed: Your Name, Level of Membership, Business Name, Business Address, Business Phone, Cell Phone, Fax #, Web Address, Email Address. Please mark one only: _____ YES, I would like to be listed in the member directory _____ NO, I would NOT like to be listed in the member directory _____ YES, I would like to be listed with the following changes/exceptions: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Paid by check #: _______________Amount: ___________________ Date: ____________ Please send this completed form along with your check to our chapter treasurer/membership coodinator: Kerry Klein 3607 Tillmont Wy. Santa Rosa CA 95403 (707) 544-8654 goklein@gmail.com We are very pleased that you are a part of IDS Wine Country and look forward to your participation in our exciting organization! |