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.

MEMBERSHIP APPLICATION 

Dues are $30 per calendar year in the U.S., Canada and Mexico (US funds only) $35 per year in the UK, New Zealand and other countries (U.S. funds only). If there are other persons in the same household who wish to be a full members, with voting rights, remit an additional $5.00 per year for each. Only one newsletter will be sent for all to share. Members may renew for 2 years and save $5.00. (I.E. for the U.S., a single membership for 2 years would be $55.)

Member's Name:_______________________________Spouse:___________________? (Spouse should be listed here if you wish it on the roster and he/she is not joining)

Name of Additional Member at same address:________________________________________

MAILING Address:___________________________________________________

City & State:______________________________Zip Code:________  Telephone:____________________ (___) check here if OK to print phone # in roster)

Interested in collecting:_______________________________________________________________________________________________ ? (Disney,Goebel,metal,etc. Limit of 36 letters)

Second member's interests:_________________________________________________________________________________ (Same categories & limit as above)

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

Were you "Referred by" someone?________________Tracy Nader___________________________

Have you ever read or heard about the our club in a book, magazine or newspaper?_______

If so, please list the publication here.______________________________________

Are you a dealer? Yes____ No____

What is your email address?___________________________________

DO YOU WANT TO RECEIVE A MEMBERSHIP CARD FOR 2005? **Yes_____ No_____
**You must include a self addressed, stamped envelope for this purpose.

Make check or money order payable to "Novelty Salt & Pepper Shakers Club"

Send To: Louise Davis - P.O. Box 416 - Gladstone, OR 97027-0416