Tri-County Celiac Support Group Membership Renewal Form

Name: _____________________________________________________

Address: ______________________________________________________

City: ____________________________ State: _____ Zip: _______      

Phone number: __________  Email address: ____________________               

Membership renewals are $25 (U.S. Funds) due by August 31st every year.

There is a $5.00 late fee for renewals received after August 31. 

I am enclosing a check or money for membership renewal in the Tri-County Celiac Support Group.

NOTE: Make payable to TCCSG
Please send this form with your check or money order to:

TCCSG Membership Renewal
385 Hamilton Street
Plymouth, MI 48170