Membership in Millennium Collectors is $5.00 per year. Please complete the following form. Required fields are highlighted with a yellow background. When you have completed the form, click on the 'Prepare Application' button. This will re-format your responses into a completed application form. Once the completed form appears on your screen, print 2 copies. Keep one copy for your records and send the other, along with appropriate payment to:     Millennium Collectors     18222 Flower Hill Way, #299     Gaithersburg, MD 20879 If you have any questions, please send an E-mail to info@millenniumcollectors.com.

Name: E-Mail: Address: City: State:   ZIP/Postal Code: Country: What do you collect? If you belong to any other collector clubs or groups, please list them. Membership Certificate:        Custom membership certificates are available on request. The cost of        the certificate is $5.00 to cover production and shipping costs.        Members joining through September 30, 2000 will be designated as 'Charter        Members'.  Charter members that order a membership certificate will have        'Charter Member' printed on the certificate.       I would like to order a membership certificate for an additional $5.00.        Please imprint the certificate with:         Method of Payment for Membership?       Check       Money Order       VISA*       MasterCard*       Discover*      * We are currently unable to accept credit card information on-line. We hope to have        this capability available soon. If you would like to pay for your membership using a        credit card, space will be provided on the completed form where you may write your        information after printing.