Please print this form and mail it when complete.

Heisey Collectors of America
169 W. Church St.
Newark, Ohio 43055

If paying by credit card, this form may be faxed to (740) 345-9638.

Call (740) 345-2932 for any questions.

Please verify the following information and fill in any blanks. Additional Family Members included.

Yes, I want to Join Heisey Collectors of America.
__ I am a New Member
__ I am Renewing my Membership
 

Name:    ____________________________________________________________

Address: ____________________________________________________________

City/State/Zip: ________________________________________________________

Phone:   _____________________________________________________________

E-MAIL:_____________________________________________________________

Have you ever been an HCA member?  ___ Yes  ___ No

Additional Family Members:_______________________________________________

Membership Renewal Form

_____  Associate Member/Newsletter yearly dues $30.00

_____ Each Additional Household Member $ 5.00
 

Please consider renewing as an Endowment Member.
Basic Associate membership dues ($30.00, plus $5.00 each additional household member) are included in each level. The remaining amount goes into the Endowment Fund. Participation is voluntary.

_____ Individual Contributing (one person) $50.00

_____ Joint Contributing (two people, same household) $60.00

_____ Family Contributing (parents and children under 18) $75.00

_____ Patron $125.00

_____ Sponsor $250.00

_____ Benefactor $500.00
 

Additional Options:

Make a donation to the Museum Operating Fund $_________

Voting Membership (one time fee) $25.00

First Class newsletter mailing (yearly) $20.00

Foreign countries will be billed Total:


Please make checks payable to HCA
MC/Visa: _________________________________________ Exp: __________
 

HCA may share my contact information with local Heisey Study Clubs: Yes_____ or No_____

For more information, call (740) 345-2932 Ext. 1

Thank you for your support !

HCA will continue to be a strong, vital organization because of the commitment of members like
 

See Also:

• HCA Main Page
• Study Clubs
• Current Officers