international nippon collectors' club
membership application
membership year: october 1 - september 30

please print:

name(s):.................................................................................................

address:..................................................................................................

city:......................................................................state:.........................

country:....................................... postal code:.........................................

phone:........................................(home) ........................................(office)

email:.......................................................................................................

are you a collector? ................................. dealer?......................................

free listing in the incc membership directory? yes.............no.............

sponsor:..................................................................................................

what are your special nippon interests? (please list):

................................................................................................................

................................................................................................................

................................................................................................................

dues per household: 1 year ($30.00)** 5 year ($150.00)**
make check or money order (us funds drawn on a u.s. bank) payable to: incc

**note: due to the increased cost of mailing incc publications overseas, there is an international postage fee of $20.00 per year for households outside the u.s. and canada. this international postage fee is in addition to the $30.00 membership dues and is payable at the time the dues are paid.

please print this form and mail to:

jennifer cavedo
incc membership
8363 dusty lane
mechanicsville, va 23116

or e-mail us at info@nipponcollectorsclub.com and we will be glad to send you a membership application.

upon receipt of your application, you will be mailed all current year membership publications.

 

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