Name:Last ________________________ First ___________________Middle Init. ____ Title: ____
Address: ___________________________________________________________________________
City: ____________________________________ State: _______ Zip Code __________ + ________
Home Phone: (______)______________________
Primary Collecting Interest: __________________________________________________________
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Email address: ____________________________

(Please place check mark next to all that apply)

I would be interested as a volunteer to: 1. Translate articles for the Journal____ 2. Write articles for the Journal____  3. Share favorite stamps, covers, etc. via the Journal____ 4. Serve as club auctioneer____ Other - please explain.

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Your comments: _______________________________________________________________________
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Please enclose your payment as appropriate - your membership will start as of the first of the next calendar quarter. Payment received by:
Dec - Feb: In US - $15.00 Others $22.00         Mar - May: In US - $11.00 Others $17.00
Jun - Aug: In US -   $ 7.00 Others $12.00         Sep - Nov:  In US - $19.00 Others $29.00 *

* (includes the following year)

 

Web Application
2/28/2006