Annual Membership Form

Today's Date

Membership is January 1 through December 31 of the current year. You will receive notice for membership renewal based on the information provided below. Make checks out to the DCCG/Treasurer 126 W. Grove St. Greenville, MI 48838

Membership Level

Single $24 Annually

Couple $48 Annually

Family $50 Annually (including children under age 18)

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email

Phone/Mobile

Spouse's First Name

Spouse's Last Name

Spouse's Email

Spouse's Phone/Mobile

Children under 18

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126 W Grove St
Greenville, MI 48838

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