2010 Membership Application
Are
You Choosing The Right Decanter Club? click here for more info.
Please fill out ALL information and then Print out this page
and send with your Membership Dues
If
you wish to pay by Visa or MasterCard click here
First Name: ______________________________________________________
Spouse Name(if couple membership): _________________________________
Last Name: ______________________________________________________
Email: __________________________________________________________
Address: ________________________________________________________
City: ___________________________________________________________
State: __________________________________________________________
Zip Code: _______________________________________________________
Birthday: ______________ Spouse Birthday(if couple membership):
___________
Anniversary: ______________________________________________________........
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FREE Price Guide Included
CLUB RATES
JimBeamClub.com/Evergreen Club Membership
Single Membership
- $20.00
Couple Membership
- $30.00
Foreign Single Membership
- $30.00
Foreign Couple Membership
- $40.00
Single International Affilated
- $33.00
Couple International Affilated
- $56.00
Foreign Single Membership
- $45.00
Foreign Couple Membership
- $55.00
.................................................................................
MAIL TO :
EVERGREEN STATE BEAM CLUB
519 NE 165th #E-12
SEATTLE, WA 98155
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