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                            Three Rivers Depression Era Glass Society
                                                2010 Membership Application

Name ____________________________________________________

Address __________________________________________________

City, State, Zip Code ________________________________________

Phone # __________________________________________________

E-Mail Address _____________________________________________

Shop Name (if you are a Dealer) _______________________________

Patterns/Items of Special Interest that you collect:

__________________________________________________________

__________________________________________________________

Signature __________________________________________________

 

Adult Membership Dues are $15 for Single or $22.50 for Family (2 people)

Junior Membership Dues are $7.50 (18 years and under)Make checks payable to the Three Rivers Depression Era Glass Society