QPS Gift Membership Application Form

  





GIFT MEMBERSHIP IS FROM:


First name: Last name:

Address:

City: State: Zip:

Email::

Phone:

Are you currently a QPS member?

YES NO

GIFT RECIPIENT INFORMATION

First name: Last name:

Address:

City: State:

Zip:

Email::

Phone:

Membership dues are in US currency for One (1) Year

US $20us

Canada $22us

$15us/Student

Please complete form, and mail your check or money order to:

QPS
P.O. Box 619
Fiskdale, MA 01518

Or, to purchase membership using paypal:

Or, to purchase student membership using paypal:

To purchase Canadian membership using paypal:

To purchase international membership using paypal:

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