VACUUM CLEANER COLLECTORS' CLUB MEMBERSHIP APPLICATION *********************************** No persons under the age of 18 years of age may join this club. We do encourage persons under the age of 18 to become a "guest member" (a parent or guardian becomes a member of VCCC). *********************************** LAST NAME ___________________________________________ FIRST NAME __________________________________________ M.I. __________ MAILING ADDRESS _____________________________________ _____________________________________________________ CITY ________________________________________________ STATE __________________ ZIPCODE ________________ HOME PHONE __________________________________________ WORK PHONE __________________________________________ EMAIL ADDRESS _______________________________________ IF A GUEST MEMBER: RELATIONSHIP TO GUEST _______________________________ GUEST"S NAME ________________________________________ GUEST'S BIRTHDAY ____________________________________ Have you been a past member of the VCCC? YES / NO If yes, when? _____________________________________ Are you a vacuum cleaner dealer? YES / NO? How did you find out about the VCCC? ________________________________ _____________________________________________________________________ Please answer the following questions so that we may create a member profile. Also, the VCCC may be able to assist you in finding machines, parts, literature, etc. (This section is optional.) How long have you been collecting vacuums? __________________________ _____________________________________________________________________ How many machines do you have? ______________________________________ _____________________________________________________________________ Do you a favorite machine(s)? _______________________________________ _____________________________________________________________________ What make(s) and model(s)? __________________________________________ _____________________________________________________________________ Are you looking for a particular vacuum(s)? _________________________ _____________________________________________________________________ If so, what make and model? _________________________________________ _____________________________________________________________________ Do you restore machines? ____________________________________________ _____________________________________________________________________ Do you have machines restored? ______________________________________ _____________________________________________________________________ What is your goal in restoring a Vacuum? Check below which applies ___ Return machine back to original appearance ___ general cleanup ___ leave in condition as found Do you collect other non vacuum related items? YES / NO If so, what are you areas of interest? _____________________________________________________________________ _____________________________________________________________________ What interests you most about vacuum cleaner collecting? _____________________________________________________________________ _____________________________________________________________________ MEMBERS AGREE TO ABIDE BY CLUB BYLAWS AND GENERAL POLICIES Member's Signature _____________________________________ Guest's Signature _____________________________________ The current membership rate is $35 for one calendar year (January through December). Checks only to be made out to VCCC and mailed to: Terry Lattz VCCC Membership Coordinator 3723 Gaviota Drive Ruskin, FL 33573