THE ADAM BINDER CLUB APPLICATION

NAME: ___________________________________________________________________


Address: __________________________________________________________________


City, State, Zip _____________________________________________________________

Phone:____________________________________________________________________

Email address: _____________________________________________________________

MSN user name(s) (if applicable):______________________________________________

If you are a member of Adam Binder Editions (ABE), what is your membership
number? ___________________________________________________________________

Would you like to be an officer in the Adam Binder Club? __________________________

Skills/abilities/talents: ________________________________________________________

___________________________________________________________________________

What other collectible lines to you collect? _______________________________________

___________________________________________________________________________

Do you want your email address shared with other collectors and dealers/stores? ________

NOTE: Information may be shared with Adam Binder Editions (ABE)
to verify Club membership.