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JUNIOR MEMBERSHIP APPLICATION 

Dues are $10 per year in the U.S., Canada and Mexico (US funds only) $15 per year in the UK, New Zealand and other countries (U.S. funds only).

Junior Member's Name:__________________________________________

Mailing Address:___________________________________________________

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

Your date of birth______________________________

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

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

Were you "Referred by" someone?___________________________________________

Are you being "sponsored" by a current club member?_______ If so, who?_________________________________

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

If so, please list the publication here.______________________________________

What is your email address?___________________________________

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

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