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

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 e-newsletter A paper copy is available for a $25 yearly subscription fee.) (Dues run from July 31 to Aug 1.)
  

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

PCGCC
c/o Ruth Ann Davis, Treasurer
P.O. 387
Southington, CT 06489
E-MAIL:ruthann11 @cox.net