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Membership Form

I / We would like to join (or renew) membership(s) to the NJ/NY Costumers' Guild (a.k.a. The SICK PUPS)

Individual membership: $10.00 per year Is this a Renewal)?
Additional family member/same household: $1.00 each. Is this a Renewal?
Number of additional memberships:

In addition, I / We would like to join the International Costumers' Guild (ICG). (optional)

ICG Membership: $8.00 per person per year Is this a Renewal)?
Additional family member/same household: $4.00 each. Is this a Renewal)?

Enclosed is a check or money order for $ (U.S. funds), made out to NJ/NY Costumers' Guild

NAME(s)

ADDRESS
CITY
STATE ZIP/POSTAL CODE
COUNTRY

PHONE(s)
E-MAIL(s)

Please print and mail this form with your check(s) to:

NJ/NY Costumers' Guild c/o Connell
50 Dove St.
Albany, NY 12210_1811