GLCS application

Name:__________________________________________

Address:_______________________________________

City:__________________________________________

State/Province:________________________________

Country:_______________________________________

Zip/Postal code:_______________________________

Phone:_________________________________________

Email:_________________________________________

Referred by
(if applicable):_______________________________

What do you collect?___________________________

_______________________________________________

Do you wish to trade with other GLCS members?  Yes or No

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GLCS Membership Dues:

Internet Membership - U.S., Canada or World - get your newsletter off the club website.
$20 one year $30 two years

U.S. Membership - get your hard copy newsletter mailed to you.
$25 one year $45 two years

Canadian Membership - get your hard copy newsletter mailed to you.
$30 one year $55 two years

World Membership - get your hard copy newsletter mailed to you.
$40 one year $75 two years

Make checks payable to GLCS and mail to:

George Beilke
1532 East 59th Place
Tulsa, OK   74105-8008
USA

Any questions, email:
secretary_glcs@lotterycollectors.com