Please fill
out this form and submit with your dues.
If you are concerned about listing your mailing address in the directory
then please consider the email only address option. Just your name, collecting interests and
club memberships will be listed along with your email address for the email
address only option.
Name____________________________________________________________________________
Address______________________________________________________________________________________
City_____________________________________________
State______________ Zip+4_____________________
Country_______________________________________
E-mail________________________________________________________________________________________
Other philatelic
clubs
___________________________________________________________________________
Bullseye collecting
interests______________________________________________________________________
Other collecting
interests________________________________________________________________________
Do you wish to be included in the
Membership Directory?
Yes(including mailing address)____________ Yes(email address
only)____________ NO_____________
Date ______________ Signature________________________________________________________________
Yearly Dues (All
in US dollars) See below for methods of payment. Check only one membership
type:
__ Adult-
$15(U.S.A, Canada, & Mexico) __
Youth (under 18 U.S.A, Canada, & Mexico)-
$7.50
__ Adult- $20(Rest
of the world)
__ Youth (under 18 Rest of the world)-
$10
Dues are enclosed
for ______ year (s) at $_______ per
year...................................................... = $ US
________
...................................................................................................................TOTAL
ENCLOSED = $ US ________
Please return
to:
Stanley Alsis
P.O. Box 102
Feeding Hill, MA
01030