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Membership Form

Annual dues are $35.00 in the U.S.A. and $45.00 (in U.S. funds) for all other countries, of which $40.00 is for a one year subscription to Prosit)

Use your printer to print this form. Fill in the form and send with a check to:

Stein Collectors International, Inc.
Dept. PSS Online
P.O. Box 342
Stevens Point, WI 54481-0342

Name:_________________________________________________

Address:_________________________________________________

City:________________________

State:______________ Zip:___________________

Home Phone #:____________________________________

Office Phone #:____________________________________

FAX #:____________________________________

E-Mail address:__________________________________________

(   ) DO NOT publish my information in the Membership Directory.

Spouse:__________________________________________________

Type of steins collected:

_________________________________________________________________________________

_________________________________________________________________________________

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