VCCA G&D Request Form

To request a G&D from 1990 - Present:  Print and answer the questions on this form. Check the following list for the cost of a G&D to your Country. Shipping & handling included.
          * U.S. Members $3.00 for each G&D or $5 for any Anniversary issue requested.
          * Canadian Members $5.00 for each G&D or $6 for any Anniversary issue requested.
          * International Members $8.00 for each G&D or $9 for any Anniversary issue requested.
Send a U.S. currency check or money order, payable to the VCCA. Address listed at the bottom of this form.

VCCA # :

_____________

Last Name:

_________________________________________________

First Name:

Delivery Address: (attach mailing label or fill out the following)

Is the delivery address on your last G&D mailing label correct?

Circle one:

Yes    No      (If no, make necessary corrections below)

Address #1:

_________________________________________________

Address #2:

_________________________________________________

City/Town:

________________________________     U.S. State:______

U.S. Zip + 4:

__________-_______

Canadian Members:

Province:

__________________________     Postal Code:__________

Members outside the U.S. and Canada:

State/Province:

__________________________     Postal Code:__________

Country:

_________________________________________________

What issue(s) are you missing?

1.     Month:

___________________     Year:_____________

2.     Month:

___________________     Year:_____________

Please send U.S. currency check or money order, payable to the VCCA along with completed form to:

VCCA - G&D Request
1751 E Route 66
Glendora CA 91740-3813

Any additional delivery instructions: