THE BOTTLE CHAPTER
MEMBERSHIP APPLICATION
Name(s):_______________________________________________
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Address:________________________________________________
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Email Address:__________________________________
Day Phone:_____________________Evening/Weekend Phone:_____________________
Fax:___________________Beeper/Cell Phone:___________________
Day & Month of Birth:_____________________
Anniversary:_____________________
What are your favorite Coca-Cola Collectible items?__________________________________________________________________________________________________________
Is it O.K. to post your Name & E-mail address on the Chapter Website? ___ YES ___ NO
All your A/C#'s with The Coca-Cola Collectors Club (Required for Membership):_________________________
Annual Membership Dues: $10 per family due on January 1st of each year.
Please enclose check or money order with this form, payable to The Bottle Chapter, and mail it to:
Joe Morales, President/Ken Berg, Treasurer
The Bottle Chapter
1000 Ponce de Leon Blvd
Suite 100
Coral Gables, FL 33134
Tel: (305) 448-7703 • Fax: (305) 448-8575 • E-mail: Thebottlechapter@aol.com
Website: www.thebottlechapter.com
Indicate: New:_____ Renewal:_____ Date:______
Note* This is a printable application and can not be emailed.
Not sponsored by The Coca-Cola Company. Trademarks used with permission
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