Online Membership, Class Registration, and/or Event Paid by Check

Please provide the following info to help us know you better. Required fields are marked with an asterisk; others are optional. *
Is this membership, class and/or event for you or a gift for someone else?
Is this a new membership, a renewed membership, a class, and/or an event? *
Check all that apply.
Name of member, class enrollee, and/or event participant *
Name of member, class enrollee, and/or event participant
Note that your name, email address, street address, website and other information will not be listed or accessible on the PhotoMidwest website.
Mailing address of member, enrolee, and/or participant *
Mailing address of member, enrolee, and/or participant
Preferred Telephone Number *
Preferred Telephone Number
Alternate Telephone Number
Alternate Telephone Number

Thank you. Please promptly send your check to:

PhotoMidwest,  attn Treasurer & Education
700 Rayovac Dr. Suite 212
Madison WI 53711 USA