National Shelley China Club Application Form

Type, Print, and Mail Application Form

for Membership in the:

National Shelley China Club

(Please print legibly, or type all items below)

You can type your data and print this form, Or you can print it and fill it in with a pen.
Address, E-mail and other contact information are below.
This form can be downloaded using the Microsoft Publisher©,
Microsoft Word© or Adobe PDF© formats.

Name

First,     Middle Initial,          Last                     Nickname

2nd Name

First,     Middle Initial,          Last                     Nickname

Address

Address (cont.)

             City                            State/Province                 Postal Code

Country

Phone

FAX If any

E-mail If any

URL Do you have a website?

What Shelley items do you collect?
YOU ARE: (Check one) Dealer Collector Both Other

Enter other club memberships:
Occupation: (optional)
Choose one of the following options: I would like single a person registration We would like to register as a family. (2 votes, 2 free ads)
I would prefer to be UNLISTED, & receive the newsletter only. Yes No
I enclose my registration fee and dues which cover membership until annual renewal on January 1st*** Yes No
Required Registration (one time) >	$10.00	(for all)
Annual Dues (one person) >	$35.00	(1 person only)
OR Annual Dues (family) >	$50.00	(If more than 1)
Extra Postage for overseas addresses >	$10.00	(If overseas only)
Extra Postage for Canadian addresses >	$2.00	(If Canadian only)
ADD fees and remit this amount:	(U.S. funds only, please)
Please Let us know how you learned of us.

I hereby accept your invitation to join the National Shelley China Club
as described herein. I agree to give NSCC permission to place my
name, and (unless "unlisted" is checked) other information above on
the Club's mailing list for contacts with other members only.

SIGNED: _____________________________________________

***Note: Dues entitle member or family to receive one each of all previous newsletters for the year. For more information, call Club Treasurer by phone (907-562-2124) or (907-344-9123) or email to imahart@alaska.net. Mail this application and check, or questions to:

National Shelley China Club
Rochelle Hart, Treasurer
591 W. 67th Ave.
Anchorage, AK 99518-1555

We thank you and hope we meet all your needs and expectations.

The Club Officers

V:Internet 03.01

Application Form | Archives | Mail List

Name
	First, Middle Initial, Last Nickname
2nd Name
	First, Middle Initial, Last Nickname
Address
Address (cont.)

City State/Province Postal Code
Country
Phone
FAX	If any
E-mail	If any
URL	Do you have a website?