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.
One Madison Street, (5B)
East Rutherford, NJ 07073
Or, pay by PayPal to firstname.lastname@example.org
Last Name:_______________ First Name:______________ Initial:___Occup'n:____________
Name of Wife/Husband/Significant Other:____________________________
Street:______________ Town: ____________________
State/Province/etc.:_________________ Postal Code: _______________________
Phone(s): Home:____________ Office:_________________ Fax:__________________
Please make cheques payable to: Canadian Corkscrew Collectors' Club.
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)