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 Sierra-Diablo Matchcover Club

Membership Application

Name:_____________________________ Telephone:__________________
 E-mail:_________________ (required, since bulletin, auction, roster are on-line)

Address:_____________________________________________________

The following information is requested so that we have an idea of each member's collecting categories to be included in the our membership listing.

General Collector________(yes)___________(no) Favorite categories...

1.___________________ 2._________________ 3.___________________

4.___________________ 5._________________ 6.___________________

Annual dues: $5 (e-bulletin); or $10 hard copy (individual), $15 (family-submit all names), $15 (Canada/Mexico), or $20 (outside N. America). Dues go from April 1st to March 31st
 
I enclose payment of $________for______memberships.
 
Birthdate (month/day):____________________
 
Signature:__________________
 
Please send application and dues to: Loren Moore, POB 1181, Roseville, CA 95678 .....AND WELCOME TO SIERRA-Diablo and a great hobby!