Print and mail this form to:
Ed BystranPlease 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.