MEMBERSHIP APPLICATION FOR THE NATIONAL AMERICAN GLASS CLUB

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If you wish to join the National American Glass Club, please complete the Membership Application Form and click SEND below. On-line payment with PayPay is available or, if you desire, you may print this page and mail it with remittance to:

Nationl American Glass Club
P.O. Box 489 Millburn, NJ 07041

National American Glass Club Membership Form

Applicant's Information

Name:

Second Name (Household Membership):

Mail Address Line 1:

Mail Address Line 2:

City:

State/Province:

Zip/Postal Code:

Country:

Phone: (optional, will not be published)

E-mail Address: (recommended)

Specific glass interests (optional):

MEMBERSHIP CATEGORIES
Annual Dues

Full-time Student - $10

Individual - $25

Institutional - $50

Household - (limit of two) - $30

Sustaining - $35

Supporting - $60

Donor - $100

Life Member-Single - $400

Life-Member Double - $500

Member's Preferences

Members name, street and e-mail address will be listed in the annual Membership Directory unless instructed otherwise below.

I would not like my name and address or e-mail address listed in NAGC's Membership Directory. Other listing instructions may be given in the message box.

I would like a link to my web site posted on our membership page at www.glassclub.org/glasssi.htm#members

WEBSITE:

In the box below, please let us know how you learned about The National American Glass Club . Thank you.

If you have any questions, please let us know in the message box below. If desired, a seasonal mailing address may be placed here.

FORWARDING MEMBERSHIP DUES

Be sure to complete the application above. You may:

Print this application and include with check by mail to National American Glass Club, P.O. Box 489, Millburn, NJ, 07041 (payments from outside the US should be by International Money Order in U.S. funds). or...

Use Pay Pal - click on "I will use Pay Pal" box plus the SEND button. For Pay Pal billing purposes, you will be asked to verify the membership category you have chosen on a "Thank You" window to follow.

Thank you!

I will use PayPal

Submit the application via

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