Membership

CORPS Membership/Renewal
Return this form with your check or money order!
PLEASE BEGIN/RENEW MY CORPS MEMBERSHIP – $15 per year
(Valid October of current year through September the following year)
Name: ____________________________________________________________________________
Address: ___________________________________________________________________________
City: _______________________________________State ________ Zip Code: __________________
Phone: _____________________________________________________________
E-mail address: _____________________________________________________________________
______ <<– Please initial if you would not like to receive promotional materials/samples from
companies that support the CORPS. We will provide them with your name and mailing address.
You may pay online using our Credit Card link or print this form and mail it to us with your check or money
order.
TOTAL AMOUNT ENCLOSED (check or money order, no credit cards): $__________ (Payable to CORPS)
Notes:
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Questions? Call the CORPS hotline at: (804) 342-0761 or e-mail us at: conclave@corpipesmokers.org
We are on Facebook at www.facebook.com/theconclave . On the web at www.corpipesmokers.org
Our mailing address is:
CORPS
P. O. Box 2463
Chesterfield, VA 23832