Printable Membership Application

Application for Membership
& Dues Renewal Form

NATIONAL ASSOCIATION OF WATCH AND CLOCK COLLECTORS, INC.

U.S. Members $65.00

International (non U.S.) $65.00 USD per year (please review the optional airmail rates). Payments for non-U.S. members may be made with U.S. funds drawn on a U.S. bank, by International Money Order, or by VISA, MasterCard, DISCOVER or Am. Express.

An additional Family Membership (for a spouse/significant other or children under the age of 18 that are living at the same address) receiving no publications costs $20.00 per year.

PLEASE PRINT OR TYPE

MR., MRS., MS., OTHER_______________________________________________

ADDITIONAL FAMILY MEMBER _______________________________________
_____ Spouse/Significant Other ______ Son/Daughter under 18

STREET__________________________________________________________

CITY_____________________________________________________________

STATE/COUNTRY______________________ZIP+4_______________________

OCCUPATION_____________________________________________________

PHONE NUMBERS:

WORK ( ___)____________________HOME (___)________________________

FAX (___)_______________________

EMAIL ADDRESS: _________________________________

BIRTHDAY ___________________________

Have you ever been a member? Yes (___) No (___)

If yes, what was your number? _________________

What are your horological interests? (Please specify, such as clocks, watches, etc.)

______________________________________________________________

SPONSOR:_____________________________ Membership # ____________

ADDRESS _____________________________________________________

______________________________________________________________

Is this a gift membership? _____ If "YES", From: _____________________
(if YES, a gift card will be included with membership card)

Gift giver's phone number: _________________________

Amount of Payment ____________ Date of Payment ____/____/____

Circle One:
Check enclosed VISA MasterCard Discover American Express

Card Number ___________________ Exp. Date _________________

Credit card security code from back of card (CSS): _____

Cardholder's name _________________________________

(For Office use -- Do Not Write Below This Line)

Enclose with remittance and send to:

NAWCC® 514 Poplar Street, Columbia, PA 17512-2130
(717) 684-8261 - fax: (717) 684-0878

Application for Membership& Dues Renewal Form

NATIONAL ASSOCIATION OF WATCH AND CLOCK COLLECTORS, INC.

Application for Membership
& Dues Renewal Form