Membership

Instructions: Please print this page and send payment to the address below




Name:________________________________________________
Street or Box:________________________________________________
City, State & Zip Code:________________________________________________
Email Address:________________________________________________
Telephone: ________________________________________________
Date: ________________________________________________




Please circle membership you desire -
 
Annual Individual Membership dues are $10.00
 
Annual Family Membership dues are $15.00 (Please include name of spouse and any children under age 18, still living at home.)
 
Annual Corporate Membership dues are $50.00
 
Lifetime Individual Membership dues are $150.00
Lifetime Family Membership dues are $200.00
 
Make check payable to: Tri-County Antique Club
 
Mail to: Tom Bechtold, Treasurer
             
27622 N. Davenport Drive
              Godfrey, IL 62035
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