Whisky Pitcher Collectors Association of America
W.P.C.A.A. (www.pubjug.com)

Membership Application

                                Name: _____________________________________________________

                                Address: ____________________________________________________

                                                ____________________________________________________

                                Country: _______________________ Email: _______________________

                                Telephone:(____)________________  Fax: (____)___________________

                                Please list types collected and the number in collection.
                                ____________________________________________________________

                                ____________________________________________________________

                                ____________________________________________________________

                                ____________________________________________________________
 

                                Duplicates for sale:   (   ) YES      (   ) NO

                                Membership fees:     (   ) U.S. $18.00
                                                                    (   ) Canada/Mexico $21.00
                                                                    (   ) Overseas $24.00
                                                                    (   ) Newsletter "Black & White" in color
                                                                           $24.00 additional

                               Payable in U.S. funds/checks,  payable to the W.P.C.A.A. drawn on U.S. banks
                               only, (print) and mailed to:
                                                                   W.P.C.A.A.
                                                                    22862 Bluejay Avenue
                                                                    Mattawan, MI 49071
 
 

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