Print this page, fill in the requested information, and mail it along with your check to the address below.

Membership Application for the National Toothpick Holder Collectors Society

Name: ___________________________________________

Phone number: _________________________________

Address:

___________________________________________

___________________________________________

___________________________________________

Business name (if dealer): ___________________________________________

E-mail address: _________________________________________

Do you want your name in the directory? Yes___ No___.

How did you learn of NTHCS? ________________________________

Make your check payable to NTHCS and mail it along with this application to:

      NTHCS
      PO Box 852
      Archer City, TX 76351

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