Pickwick Chapter of the Beer Can Collectors of America

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Pickwick Chapter Membership Application/Renewal Form

Membership dues are $5.00 per year, increasing to $8 per year as of January 1, 2005 for U.S. residents only. Please contact us if you're applying from outside the U.S.

Please fill out the form below then click "Sign me up!." When the form has been successfully submitted you'll receive a call back to confirm your application and welcome you to the club. Note: Membership benefits don't begin until your dues payment has been received! Once payment has been received, we'll e-mail you a login and password that will allow you to access the members-only features of the site.

Renewing members must fill out all required fields as well, in order to keep your information up-to-date.

If you have difficulty with the form, you can print out a pdf version and mail it along with your payment.

Required fields are marked with *

Name*

Phone number*

E-mail address*

New Member

Renewal

Mailing address 1*

Mailing address 2

City*

State and ZIP*

What do you collect?
Be as specific as possible. (Example: "flat top beer cans from Michigan" or "any sports breweriana" etc.)

For how long have you been collecting?

Are you a BCCA member?

Yes

If not, please tell us why not

Would you attend a Canvention if it were held in N. England?

Yes

What factors would most influence your decision to attend or not attend?

Would you like to receive chapter news, show reminders, etc. via email?*

Yes

Through which method would you most prefer to receive/read our newsletter?*

	Print via USPS
	Online at Chapter Web site
	Via e-mail
	No preference

Please make your check payable to Pickwick Chapter and mail it to:

Pickwick Chapter
c/o Dave Lang
152 Crestview Drive
Jaffrey, NH 03452