MEMBERSHIP APPLICATION FOR THE CCCC

Canadian Corkscrew Collectors Club.

Membership in the CCCC provides you with excellent value and many benefits such as a very informative Newsletter four times per year, an up-to-date membership directory, the opportunity to contribute and receive corkscrew related materials, the right to register and attend the yearly Annual General Meeting, small group regional get togethers and the opportunity to correspond with other members addicted to corkscrew collecting. You will get involved in trades, buys and sells and the chance to assist and get help in corkscrew related questions.

The annual membership is only $48.00 USD for all members. This fee covers the cost of newsletters, correspondence, membership card, club pins etc. Please fill out fully the application form below. The information will be used to present a complete roster list to you and to assemble some statistical information on the Club.

Thank you for your anticipated prompt response.

MAIL TO:

CCCC/Milt Becker
One Madison Street, (5B)
East Rutherford, NJ  07073
U.S.A.
e-mail: ccccdues@aol.com

Or, pay by PayPal to  ccccdues@aol.com

Last Name:_______________      First Name:______________  Initial:___Occup'n:____________

Name of Wife/Husband/Significant Other:____________________________

Address:

Street:______________   Town: ____________________

State/Province/etc.:_________________  Postal Code: _______________________

Country: _____________________

Phone(s): Home:____________ Office:_________________   Fax:__________________

e-mail: _______________________________

Statistics: Year first started collecting?_______    How many pieces (approx) in collection? ______

Member of other relevant Clubs? JFO, ICCA, CFTB, AICC Other(s): _____________(Circle all applicable)