| CRESCENT CITY DEPRESSION GLASS SOCIETY MEMBERHSIP FORM One year membership fee: $35.00 per person Membership year from August to July |
| Date:___________________________________ Check one: _____ New member ___ Renewal Name ____________________________________________________________________________ First (if married couple, give both names) Last Address __________________________________________________________________________ (Please include apt. #) City State Full 9digit ZIP Telephones: Home ( )__________________ Work/Cell ( )____________________ Email Address: _____________________________________________________________________ (Please indicate #1 or letter L if necessary) Use lowercase only unless you have captial letters in your address. Birthday : ______/________ (Used for recognition at monthly meetings.) month and day only List patterns/manufacturers and glass collectibles below or on back of page. Volunteer! CCDGS needs you. A check which committees or activities I an volunteering for. Glass Auction __ Charity ___ Newsletter ___ Field trips ___ Collector's Fest ___ Dec. Banquet ___ Library ___ Historian ___ Hospitality ___ House Tour ___ Photographer ___ Refreshments ___ Program ___ Raffle/door prizes ___ Show'n'Tell ___ Summer Social ___ Sunshine ___ Club officer ___ Office: Glass Show: _____ Committee Chair ___Show Volunteer Talents I can share: ___________________________________________________________________________ THIS FORM MUST ACCOMPANY YOUR DUES PAYMENT Please print 2 forms, fill out and send in both forms. Enclosed is my payment for my dues for ________-_______. Years Membership rosters can be mailed if $2.50 is included with your dues payment. If paying dues in Feb. or later, dues would be $17.50 each for 1/2 year. Check where appropriate: $35.00 (one person/one year) ____ $70.00 (two persons/one year) ____ $ 2.50 (for roster mailing) ____ $ 17.50 (one person/1/2 yr.) ____ $ 35.00 (two persons1/2 yr.) ____ Total Amount Enclosed $ ______________ ___ check No. _____ ____ cash Make checks payable to Crescent City Depression Glass Society. Please print /send 2 forms. Mail to : Vicki Hale Treasurer, CCDGS 3929 S. Pin Oak Ave., New Orleans, LA 70131 |
| Please fill in all blanks. Print legibly. Print 2 copies of this form. Information on this form will be published in the yearlymembership roster. |