29 Pond Road
Hawley MA 01339
(413) 339-5347
fax:(413) 339-4377
Membership ApplicationJanuary 1st - December 31st
| |
| Name: _________________________________________________________________ | |
| Address: ________________________________________________________________ | |
| City: ____________________________________________________________________ | |
| State:_____________________________ | Zip Code: ________________________ | Date of Birth: ________________________ | Telephone: (day) (______) ____________ |
| Date:_____________________________ | (evening) (______) __________________ |
| Chapter:_______________________________________________ | |
| Email:_________________________________________________ | |
| Check MasterCard VISA | |
| Account #_____________________________ | Exp._______________________________ |
| Signature______________________________ | Date______________________________ |
|
Membership includes issues of our newlsletter, ability to advertise in newsletter, liability insurance coverage at any Vintagers event, admittance to all Vintagers events countrywide including the Vintage Cup Membership is for one calendar year, from January 1st to December 31st Renewals must be received by March 31st or there will be an additional charge of $10 Annual Membership $60 Individual_____ Annual Membership $100 (couple) _____ Annual Membership $150 (corporate)_____ |
|