International Coleman Collectors Club, Inc.

Membership New and Renewal Form

Name:
Member Number:
Address:
City:
State: (Prov):
Postal Code:
Country:
Phone:
E-Mail:
Date:

Would you like to participate in some function of the club? Yes No
This is a: MEMBERSHIP RENEWAL NEW MEMBERSHIP
INDIVIDUAL $25
FAMILY $30
INTERNATIONAL $30
Please make your check or money order out to "International Coleman Collectors Club, Inc." and send it and this form to: to:
Charleen Becker
1822 E. Fernwood
Wichita, KS 67216