Membership Information Request

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I'm Interested!

To join the IPBA:

Fill the form out online (type your data into the boxes)
Print the form twice - one for your records
Click the "Send" button to send your personal details to the Membership Secretary
To pay the dues by credit card, write your card details onto one of the forms you printed
or attach your check (US bank accounts only and payable to "IPBA")
Send the form by mail to Susan Arthur, PO Box 425, Pennington, NJ 08534 USA

If you'd simply like more information, complete the bottom section only and click "Send"

I would like to join the IPBA: (Required fields are marked *)
*Name:
*Address:
*City:	*State/Prov:
*Zip/Postal Code:	Country:
Phone:	Fax:
Email:
Payment:	I will pay my annual dues by
Card Number:	__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Exp. Date:	_____/_____
Card Type:	_____ Visa _____ MasterCard
Signature:	________________________________________
	Click on the PayPal logo, log in to your account and make the appropriate payment to IPBAperfumebottles@hotmail.com
	Please confirm your payment amount
Your address will be printed in our annual members directory unless you want to keep it private. Do you want to keep your details private?
Please tell us about your collecting interests:
How did you hear about the IPBA? Now click "Send"
OR, I would like some more information:
Your Name:
Phone:
Email:
Please tell me more about:

Membership Fees:
  $45 USA
  $50 Canada (US dollars)
  $55 Elsewhere
(the differences are solely to cover additional postage)
Note: Due to exchange costs we require payment from non-US members by credit card or US funds.

Address email inquiries to Susan Arthur, Membership Secretary
Email: IPBA_Membership@verizon.net