The NJ/NY Costumers' Guild

Membership Form

I/We would like to join the The SICK PUPS A.K.A. the NJ/NY Costumers' Guild.

Individual membership: $8.00 per year
Additional family member/same household: $1.00 each.
Number of additional memberships:

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

ICG Membership: $8.00 per person per year

Additional family member/same household: $4.00 each.

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
E-MAIL

Please print and mail this form with your check(s) to: NJ/NY Costumers' Guild PO Box 366 Plainsboro, NJ 08536-0366