Victorian Tea Society

APPLICATION for MEMBERSHIP

Please fill out this information sheet, sign and return with your check made payable to the

Victorian Tea Society or VTS in the amount of $20.00 which will cover your membership

through February, 2009.

PLEASE PRINT

Member Name: _____________________________________________________

Mailing Address: _____________________________________________________
                                 Number and Street

_________________________________________________________________
                                 City Zip Code

Home Telephone: (______) __________________________________

FAX Number: (______) ______________________________________

CELL #: (______) __________________________________

E-Mail Address: _______________________________________________________________________

Birthday: _____________________________

Days you are available for tea ________________________________________________________

                                                                                        Please mail to:  Victorian Tea Society
                                                                                        c/o Julie Schossow, Membership Chairman
                                                                                         22055 Woodcreek Ln.
                                                                                         Wildomar, CA 92595

The Victorian Tea Society

Applicants Release of Liability and Authorization to Publish

I, ___________________ (please print your name) hereby apply for membership in the "VTS."

I understand that as part of the application process I submit this informational questionnaire, which divulges

information relative to myself. I give my permission to the VTS to publish this information generally, in print and verbally to anyone who request it with an apparent nee which is solely related to the operation of VTS, its’ functions or purposes.

Dated: ______________

Applicant’s Signature: ________________________________________________