Please make checks payable to National Bottle Museum and Mail to

Please Print Name and Full Mailing Address
Please make checks payable to National Bottle Museum and Mail to:

Membership Chairman National Bottle Museum
76 Milton Avenue
Ballston Spa, NY 12020

Name:_________________________________________________________

Street or P.O. Box: ______________________________________________

City: __________________________ State: __________ Zip: ___________

Amount Enclosed: $_______________New: ____ Renewal: ____ Gift: ____

Bottle Club (if any): ___________________________ Date: ____________