Date _______________________

Required information:

Name(s):________________________________________________________

Address:________________________________________________________ 

City_______________________________State_________Zip_____________

Phone:_____________________eMail:_______________________________

What time zone do you live in?______________________________________

  May we list the above information in the club directory?              Yes / No

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Optional Information:

How long have you been interested in and/or collecting marbles?________

Are you interested in a specific company/artist?____________________

What is your age bracket?____under 20____21-40____41-60____61+

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                                                              Membership Dues:

(Membership dues cover 2 people per household and runs 5/1-4/30 with renewal May 1 each year)

Membership:  $20