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Department 56 Dreamers Membership Application
Date: ___________ 
Complete Name(s): _______________________ 
Street: __________________________________ 
City: ___________________________________ 
State: __________________________________ 
Zip: ____________________________________ 
Phone Number (home): ____________________ 
Fax Number: _____________________________ 
Email Address: ___________________________
   We are trying to get the Membership Directory up to date. We ask that you PLEASE complete this form, and either bring it to the February 18th club meeting or mail it to Matt at: 
Matt Lake
411 Spring Ave
Clarksburg, WV 26301

May we include you in our public club directory? [__] Yes [__] No

            The D56 collections you collect (check all that apply):

[_]Dickens Village [_]Christmas in the City
[_]Alpine Village [_]Little Town of Bethlehem
[_]North Pole [_]New England Village
[_]Disney Parks [_]Snow Village
[_]Snowbabies [_]Snowbunnies
[_]Winter Silhouettes [_]Story Book Villages 
[_]D56 Ornaments - WHICH ______________  [_]Seasons Bay Village
[_]Other: _________________________
[_]Other: _________________________