P.C.A. Membership Application

PLEASE NOTE: P.C.A. Membership is based on the calendar year January - December. Collectors joining after October 1, will have membership extended through the end of the following year. The P.C.A. sends renewal notices to members in November.

Check here if you DO NOT want to be listed in the membership directory

Full Name:
Company: (if applicable)
Street Address:
City:		State/Province:
Postal Code
Member Location	USA Canada	if Other, click and specify
Telephone:	Home/Evenings	Office/Days
Fax:
E-Mail:
Collecting Interests:
Would you be interested in occasionally volunteering (sending) articles, pictures, or information to be used in our newsletter "THE PENnant"? Yes No
Pen Collectors Membership Length: USA and Canada Residents: (1) One Year for $40 (3) Three Year for $105 Outside USA and Canada: (1) One Year for $60 (3) Three Year for $150		USA ONLY: Youth Rate for (1) One Year for $20 Your Birthdate: MM/DD/YYYY:

Please Type In The Amount You Will Be Paying: (in $US)

Please Specify Your Payment Method:
PAYPAL (payment button will be shown on NEXT page!)
Mailing a Check
Mailing a Money Order

Please note: Your membership will not take effect until
your payment has cleared our bank.

PayPal may also be used for submitting Donations
and Library purchases

Keeping The History of Writing Instruments Alive Through Member Support and Community Education

P.C.A. Membership Application