Antique Glass Salt and Sugar Shaker Club

Antique Glass Salt and Sugar Shaker Club (AGSSSC)

MEMBERSHIP INFORMATION FORM

Membership dues per household are only $25 per year.
New memberships paid after October 1st will include the next calendar year.
Your Name:___________________________________________________________________________

Other name, same address: ______________________________________________________________

Street Address: ________________________________________________________________________

City, State, Zipcode:_____________________________________________________________________

Telephone: ____________________________________________________________________________

Email Address: _________________________________________________________________________

How You Learned About AGSSSC: __________________________________________________________

_______________________________________________________________________________________

Collecting interest: _______________________________________________________________________

_____ I have enclosed $25 for annual membership.

_____ I give permission for the above information to be included in the AGSSSC
Membership Directory unless otherwise requested.

Fill out this form and mail with dues enclosed to:
Scott Roland
PO Box 262
Schenevus, NY 12155





Home