Air Capital Carnival Glass Club

~ Membership Application ~

Membership is $20.00 per year for U.S. citizens
$22.50 for our Canadian Friends
$25.00 for other Foreign Memberships

Annual renewal is due in October of each year.
Membership fee must be paid no later than December to
continue receiving the ACCGC Newsletter.

Please print clearly and fill out all the requested information below:

Name:_____________________________________________________

Address:___________________________________________________

__________________________________________________________

City:________________________State:_______ Zip Code:___________

Country:_____________________  Mailing Code:___________________

Telephone:_________________________________________________

E-Mail Address:______________________________________________

Mail the completed application and check payable to A.C.C.G.C. to:

Randy Thach, Secretary
4500 N. Ridge Road
Wichita, Kansas 67205