First Name(s): 
Last Name:     
Address:         
Address #2:    
City:               
State:             
Zip Code:        
Country:          
Phone:            
Type of Mail:    Regular Postage 
                           First Class     

Collecting Interests: 

Local Bottle Club:    

Do you wish to be listed in the Membership Directory?  Yes  No 

Do you wish your spouse or children to be Associate Members?  Yes  No 

If you chose an Associate Membership, please be sure to include your spouse
and/or child(ren)(s) name(s) below and include an extra $5.00 fee for each Associate Membership desired:



This Associate Membership will coincide and become due again at the time of renewal for the Primary Membership.

E-mail address:    

Payment options are available through Paypal after this form is processed.

REMEMBER: Your membership to the Federation of Historical Bottle Collectors, 
and your subscription to Bottles & Extras, will not be processed until payment is made!

• United States
  
  • Regular postage -- $ 30 per year
  • First Class Postage -- $ 45 per year
    
• Canada
  
  • First Class Postage -- $ 50  (U.S. dollars)
    
• All other foreign countries
  
  • First Class Postage -- $ 65 (U.S. dollars).
    

Please send your check or money order, in the appropriate amount, made payable to:

The Federation of Historical Bottle Collectors
Bottles & Extras
c/o June Lowry, 401 Johnston Ct., Raymore, MO 64083

OR click the Payment Option on your form confirmation page to pay now.

Please Note: Allow 6 - 8 weeks from the time you send in your check until you receive your first issue of Bottles & Extras.

If this form fails to submit your application, you may print a copy of one of the following documents.
Then mail your completed application with your check.

Adobe Acrobat Reader is required to view and print these files:
Individual Membership Application	Club Membership Application

   Please send your membership questions to June Lowry (Business Mgr.)