Please e-mail spacing.guild.net@gmail.com the following information or send this in the mail with your dues.

Full Name __________________________________________

Username __________________________________________

Address __________________________________________

City, State, Zip _________________________, ____ __________

Phone Number (________) _________ - ___________________

Preferred Email __________________________________________

____ I want to continue my membership with The Spacing Guild

____ I want to cancel my membership with The Spacing Guild