Membership Application
The Casino Chip and Gaming Token Collectors Club, Inc.
Name:  
Address:  
City:  
State: Zip:   
Phone: E-Mail:  
Collecting Interests: Chips       Tokens       U.S.       Foreign       Other  
Please publish my: Name and Address       Phone       in the club membership directory  
Please publish my name, E-Mail address and collecting interests on the club web page: Yes       No  
  Do not publish my information in either  
I have enclosed my annual dues for: One Year $30
Associate $5 Member in same household as a regular member
Foreign $35 Postal money order or US funds
For FIRST CLASS magazine delivery add $12 (U.S. Only)
 		  
Foreign mailings are First Class, regular mailings are Third Class unless First Class is added.
Print this completed application and mail with your check made out to CC&GTCC to:
CC&GTCC Membership Officer, Ralph Myers, PO Box 35769, Las Vegas, NV 89133
Sponsored by Scott and Estelle Hartman, Member #LM 501-6, LM 6625-89