Save this page to your computer and print it out or hit PRINT in the browser and fill out all information and send to address below.

ARIZONA CHAPTER MEMBERSHIP APPLICATION 

Dues are $5.00 per per person per calendar year. Please print or type the information below.

Name:___________________________________________

MAILING Address:__________________________________________________________________________

City & State:______________________________Zip Code:________  Telephone:____________________

Interested in collecting:__________________________________________________ ? (Disney,Goebel,metal,etc.)

How did you find us, or where were you given information about our Club?_____________________________________________

Were you "Referred by" someone?_______________________________________

Are you a current member of the National Shaker Club? .YES_____ NO_____

What is your email address?________________________________________________

Make check or mail order payable to: "Laura Albanese"

Send To: Laura Albanese, 26618 N. 57th St. Phoenix, AZ 85085