Other Philatelic Societies to which you belong:

APS: _____ ATA: _____

Other:

Have you ever been expelled from or refused admission to any philatelic society?

No: _____ Yes: _____

If 'Yes', please explain:

Optional Information:

Primary Phone:
2nd Phone:
Fax:
Email Address:
Age:
Occupation:

I certify that the information on this application is accurate.

Signature:

The membership year runs from January 1 to December 31

Dues For	One Year	Two Years
US Applications	$20.00	$38.00
Rest of the World (via Air Mail)	$36.00	$70.00
Dues must be in U.S. funds drawn on a U.S. bank, or an International Money Order

I would like to donate an additional amount to the Society: $____________
Donors will be acknowledged in the Bulletin as follows:
Contributor ($1 - $19)     Sustaining ($20 - $49)
Patron ($50 - $99)     Benefactor ($100 and up)
_____ Check here if you do NOT wish your gift announced in the Bulletin

Register your collecting interests:

_____ USA by meter stamp type _____ USA by meter number	_____ USA by town _____ USA by postal history
_____ Other country/countries:
_____ Slogans by topic:
_____ Other specialty/specialties: