SOUTHEASTERN MATCHCOVER CLUB MEMBERSHIP APPLICATION
PLEASE HIGHLIGHT AND PRINT PAGE
PLEASE PRINT INFORMATION
NAME:___________________________________________TELE # _____________________
ADDRESS:___________________________________________________________________
CITY:_________________________________________STATE:_________ZIP:____________
EMAL ADDRESS:______________________________________________________________
THE FOLLOWING INFO IS REQUESTED SO WE CAN HAVE AN IDEA OF EACH MEMBER'S
COLLECTING CATEGORIES TO BE INCLUDED IN THE ANNUAL MEMBERSHIP LIST.
GENERAL COLLECTOR: YES_____NO_____ MAIL TRADER: YES_____ NO_____
FAVORITE CATEGORIES:
1______________________________________2__________________________________
3______________________________________4__________________________________
5______________________________________6__________________________________
FIRST YEAR INCLUDE $1.00 REGISTRATION FEE IN ADDITION TO ANNUAL DUES
INDIVIDUAL $5.00 / FAMILY $6.50 (PLEASE SUBMIT ALL NAMES)
DUES ARE FROM JAN 1 THRU DEC 31 EACH YEAR.
I AM ENCLOSING PAYMENT OF ____________FOR ____________MEMBERSHIPS
BIRTHDAYS: MO_____________DAY_____________; MO______________DAY______________
SIGNATURE________________________________________
SPONSORED BY____________________________________
PLEASE RETURN COMPLETED FORM AND DUES PAYABLE TO:
SOUTHEASTERN MATCHCOVER CLUB
ATTN: BILL HAYES
13553 SAN RAFAEL DRIVE
LARGO, FL 33774-4638
THANK YOU FOR JOINING OUR CLUB!!