GLCS application

Name:__________________________________________

Address:_______________________________________

City:________________________________

State/Province:______________________

Country:_____________________________

Zip/Postal code:_____________________

Referred by
(if applicable):_____________________

One year membership dues are $15.00
($27.00 outside North America)

Make checks payable to GLCS and mail to:

George Beilke
1532 East 59th Place
Tulsa, OK   74105-8008
USA

Any questions, email:
secretary_glcs@lotterycollectors.com