Canadian Corkscrew Collectors Club

Membership application form


Print and mail this form to:

Ed Bystran
CCCC Membership Chairman
P. O. Box 386
Aptos, California 95001, USA

Please make cheques payable to: Canadian Corkscrew Collectors' Club


Membership in the CCCC provides you with:

The annual membership fee for ALL MEMBERS is only $48.00 US. Non-USA residents please remit $48 using an International Money Order or U. S. Dollar traveler's check only. All payments must be drawn on a U. S. bank. Please do not wire funds unless you are prepared to pay all fees. Payment can also be made by Paypal to: CCCCdues@bystran.com Note: Membership is for the calendar year.

NAME:________________________________SPOUSE / SIGNIFICANT OTHER____________

ADDRESS:___________________________________________________________________

____________________________________________________________________________

CITY / STATE / COUNTRY / POSTAL CODE:______________________________________

TELEPHONE (with country and area codes): Home:____________________________________

Office:__________________________________ Fax:_____________________________

email address:_________________________________________________________________

For the record: Year started collecting?________How many pieces in collection?______________

Other club memberships:_________________________________________________________

Comments:___________________________________________________________________

Note: Membership is for the calendar year. New members will receive all newsletters for year in which they join. A collector joining in the second half of the year will receive the back issues for the year with renewal due for the following year. You may submit the application for the current year and the following year with $96.


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