OREGON STATE BUTTON SOCIETY MEMBERSHIP APPLICATION

from 1/1/20____ to 12/31/20____ (please indicate years)

Name____________________________Telephone_______________

Address______________________________________________

City__________________________State_____Zip______________

email____________________________________
____Yes, publish my email in bulletin

Check where applicable
_____regular; $20.00 (if later than 1/31)
_____discount; $15.00 (check must be sent before 1/31)

_____joint membership (one bulletin, 2 adults) ; $25.00(if later than 1/31)
_____joint discount; $20.00 (check must be sent before 1/31)

_____Junior; under 16 years;.$2.50

Circle
• Renewal

• New Member

• ___ Yes, I would like to purchase OSBS enamel button for $7 (shipping included)
  Or, order this button separately.
  
  

  Enclosed $__________________
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Make check payable to Oregon State Button Society
and send forms and check to:
Ilse Christensen
25061 decker Rd., Corvallis OR 97333