PO Box 2210, North Bend, WA 98045, Ph. 425-831-8789, e-mail scottloos@msn.com.

Check type of membership for which you are applying:
__ Individual (annual dues $12.00), __ Family (annual dues $15.00 until otherwise announced)
__ New __ Renewal __ Upgrade

Please type or print:
Name: ________________________________________________________________
Address: ______________________________________________________________
City/state/ZIP: __________________________________________________________
Phone (with area code) (optional): __________________________________________
e-mail address (optional): _________________________________________________
Other Family Members: ____________________________________________
Collecting Interest: ________________________________________
How did you hear about us? _________________________________
Signature _______________________________________________

I'd like to see the SCC do the following:
___________________________________________________________________________
___________________________________________________________________________

SCC use only:
Proposed by: ___________________________
Dues paid: $____________
Admission date: ____________
Membership # __________

Date of first reading: ____________
Date of second reading: ____________
Date approved: ____________