First Name: Last Name: Title/Position: Winery Name: Are you bonded in WA?: TTB ID #: Organization Name (if not winery): Address 1: Address 2: City: State: Zip: Phone: Fax: E-mail: Web Site: Production Level (in gallons): Membership Type (Regular/Associate/Affiliate/Industry): Dues Contribution (in dollars): Any issues or items you want to bring FWWS board attention to?:

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