PCGCC Application

(Print this page, fill it in, and mail to the address below.)

Membership Application for the Phoenix and Consolidated Glass Collectors Club

Name(s): ___________________________

Phone: __________________________
E-mail: __________________________
Address:
___________________________
___________________________
___________________________

Business name (if dealer): ___________________________

______ Include me in the membership roster: YES ____ NO ____

How did you hear about the club?:
_____________________________________________________________
_____________________________________________________________

Dues: $25.00 for single; $35.00 for couple
(dues include a subscription to our newsletter).

Make checks payable to: Phoenix and Consolidated Glass Collectors Club
Mail to:


PCGCC
c/o Ruth Ann Davis, Treasurer
P.O. 387
Southington, NCT 06489
E-MAIL:SSROS@aol.com

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