Membership Form

Membership Application for the Phoenix and Consolidated Glass Collectors Club

We invite you to join us as a member. Hit the print icon in the upper right to print this form.

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How did you hear about the club?:

 

 

Dues: _____ $25.00 for single; _____ $35.00 for couple

(dues include a subscription to our quarterly e-newsletter. If you would like to receive a paper copy
of our newsletter, add an additional $25 to your application)

Make checks payable to: PCGCC

 

Return by Mail to:
PCGCC
Tom Jiamachello, Membership Secretary
41 River View Drive
Essex Junction, VT 05452
E-MAIL: This email address is being protected from spambots. You need JavaScript enabled to view it.
Our membership year runs from August 1 - July 31.

Questions? Contact Sue at 516-579-4474 or via e-mail at: This email address is being protected from spambots. You need JavaScript enabled to view it.
or
Contact Tom at 802-878-2682 or via e-mail at: This email address is being protected from spambots. You need JavaScript enabled to view it.
Member Name(s):
___________________________


Home Phone (including Area Code) : __________________________
Cell Phone:
__________________________
E-mail:
__________________________

Mailing Address:
___________________________
___________________________
___________________________

______ Include me in the membership roster: YES ____ NO ____
Business Name : ___________________________
(optional)

Business Address : _________________________
(optional)

Business Phone: ___________________________
(optional)
Business Website: __________________________
(optional)