HEARTLAND REGION, EMBROIDERERS' GUILD OF AMERICA, INC.

Chapter Name ________________________________________

Date __________________________

Reporting Period

Membership Report

(Check one box)

(Fill in each blank line and the total)

1^st quarter, ending 3/31
Report due 4/15

2^nd quarter, ending 6/30

Report due 7/15

3^rd quarter, ending 9/30

Report due 10/15

4^th quarter, ending 12/31

Report due 1/15

Annual report due 1/15

Number of members at end of last quarter	_______
Additional Members:
# of new primary members	_______
# of new plural members Plural within Heartland _____ Plural outside Heartland _____	_______
Less Non-renewing primary members	_______
Less Non-renewing plural members	_______
Total number of members	_______

Region Dues to be paid this quarter

$2.00 per member, make checks payable to Heartland Region EGA

No. of new members	_______	Check # ________
No. of plurals from outside Heartland Region	_______
Number of renewing members	_______
TOTAL x $2	_______	$ ________.00

Name of person completing this report

_________________________________________________________

Address:

_________________________________________________________

Email: __________________________________________________

Mail report and check to Region Treasurer. Address is listed in each issue of Heartbeats.

Heartland Policy: "Dues for plural members shall be paid only by the first Heartland Region Chapter on individual member joins."

*If a chapter sets their dues at $40, $29 goes to national. Of the remaining $11, $2 goes to Heartland, leaving $9 for the chapter. A member of a primary chapter in Heartland becoming a Heartland plural pays $9. Outside Heartland plurals still pay $11. If the total dues are higher than $40, the same allocation applies.

Heartland Region Officer Notebook
Region Forms and Reports
Revised 4/2006
Section VII-B

Report Form

Heartland Region

The Embroiderers' Guild of America, Inc.

Region Dues to be paid this quarter

Mail report and check to Region Treasurer. Address is listed in each issue of Heartbeats.