Please Print
Circle Type of Membership: INDIVIDUAL - $20/yr. FAMILY
of 2 - $30/yr. ($5 each add'l) at same address)
Or...NEWSLETTER Subscription ONLY - $10/yr.
Mailing Address_________________________________________E-mail address____________________________________
City________________________________State_____________________Zip Code_______________
Residence Address if different from mailing __________________________________________________________
Home Phone ( )_______________________How did you hear about us?__________________________________________
If from a dealer, which store?__________________________________
What first names would you like listed on your name badges (if use nicknames, etc)?_____________________________________
All Members signatures____________________________________________________
QUESTIONNAIRE...Please help us make YOUR club interesting by answering the following questions
Please circle your Dept 56 collections. SV...CIC...NP...NEV...ALP...DIS...BETH...SBAY.
..SNOBAB...HOLYLAND...STORYBK
How long have you collected each?: ________________________________________________________
Do you collect items other than D56?_____If so,
what?______________________________________________
________________________________________________________________________________________________________________
Any suggestions/ideas for future club meetings?_____________________________________________________________
________________________________________________________________________________________________________
Would you be willing to serve on any future committees?___________________________________________________
How far would you be willing to travel to an event or meeting? (state in either miles or minutes)_______________________
May we list your name /address/phone/email on a roster given to other club members only? (Circle) YES........NO
What made you decide to join and what are you hoping for?______________________________________________________
_________________________________________________________________________________________________________
Do you have any talents you would be willing to share with us?______________________________________________________________
PRINT THIS FORM AND MAIL WITH CHECK TO:
The DepartMENTAL 56ers
P.O. Box 835, Lakeville, MA 02347
For More Information Call Our Hotline, 1-800-758-3685 or Contact Us at Mental56er@aol.com