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IceScreamers Membership Application

Please print this one-page application, and mail with a check or U.S. Money Order for
$20 USD (U.S. Addresses) or $ 30 USD (International Addresses) membership fee payable to:
THE ICESCREAMERS
P.O. Box 465
Warrington, PA 18976
Or Contact us at Phone Number: 1-215-343-2676

Name:_________________________________________________
Company Name:__________________________________________
Address:_______________________________________________
City:___________________State:___________Zip:____________
Country:______________________________
Email:_____________________Phone:(_____)________________
Primary Area of Interest:

_______________________________________________________________________

_______________________________________________________________________

I desire a confidential membership. I understand that I will receive the quarterly newsletters, but my name and membership information will be omitted from the Icescreamers membership Directory.