OMPC Membership Application Form

Enclosed is my remittance (check or money order) for membership in the 

Ozark Mountain Pepsi Club.  Please enroll me for:

1 Year- $18______

2 Years - $36  ________

Outside U.S.A., I Year - $23 ___________

Membership is for one person or the entire household.

NAME: (PLEASE PRINT) _____________________________________

STREET ADDRESS: _________________________________________

CITY:_____________________________

STATE:_________

ZIP:____________

Phone (home): ______________________

Phone (work): _______________________

Email: ____________________________________________________

Web Site: _________________________________________________

I buy ____ sell ____ trade ____     Pepsi collectibles (check all that apply)

Comments:

Please make checks payable to: Ozark Mountain Pepsi Club (or OMPC)

Remit payment to: 

Linda McClanahan: 3715 Dixie Drive South, St. Ann, MO 63074