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On-line New Member

2012 SEGC Membership Application

Membership Details

Membership dues for 2012 are $15.00 per person (plus a one-time initiation fee of $10.00) or $20.00 for two or more persons residing in the same household (plus a one-time initiation fee of $10.00).

Please complete the form below and click on Submit. By clicking Submit, you agree to abide by the Constitution and By-Laws of the Club and to support its activities. You will be redirected to pay your renewal dues using PayPal. A $2.00 convenience fee will be included. Membership is for a calendar year, January to December.

Application Instructions and Details

Once submitted, your information feeds directly into our database. To assist us with data management, please use proper casing when completing the form (e.g., capitalize the first letter of names). Please do not type everything in all uppercase or all lowercase letters. Telephone numbers must include the area code and not include any spaces, dashes, or other characters. Required fields are shaded yellow.

Person 1
First Name
Last Name
Email Address
Occupation
Person 2
First Name
Last Name
Email Address
Occupation
Mailing Address
Address
City
State
Zip
Telephone Numbers
Telephone 1  Type 
Telephone 2  Type 
Telephone 3  Type