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I. ____________________________________________ hereby
make application
(Mr., Mrs., Ms. or Miss) (print name)
for membership (reinstatement) in the Precancel Stamp Society,
Inc., and enclose herewith the sum* of ________________ as initiation fee,
dues and subscription to Precancel Forum in accordance with the schedule
shown on the reverse. I understand the entire amount will be refunded in
case admission to the Society is refused. I hereby agree to comply with
all regulations governing the society.
_____________________________________________
(signature)
Address:______________________________________________________________________
(Box number is satisfactory if accompanied by street address)
City:_______________________________________State:________________Zip:___________
Date of Birth (m-d-y)____________Employer or Business
Connection: _______________
Collecting
Interests:_____________________________________________________________
Membership in other Philatelic Societies: ______________________
Do you wish to exchange with other
members?___________________
If applicant is more than 17 years of age,
names and full addresses of two references (other than the preparer) must
be furnished.
| References |
(1) Name |
__________________________________ |
| |
Address |
__________________________________ |
| References |
(2) Name |
__________________________________ |
| |
Address |
__________________________________ | If Applicant is under 18 years of age, the following must be
filled out by a parent or guarantor satisfactory to the Board of
Governors: To The Board of Governors of the Precancel Stamp Society, Inc.
In full accordance with the rules of your Society, I hereby bind myslef as
guarantor for the above applicant and agree to hold myself responsible for
all debts of said applicant to your society until the applicant reaches 18
years of age.
| Name: |
___________________________________________ |
| Relationship to the
applicant: |
___________________________________________ |
| Address: |
___________________________________________ |
| City: |
___________________________________________ |
| State: |
_______________________ Zip:
________________ |
Proposed by
John R Gordon PSS No. 7557
Please print, complete and mail with
your application dues to:
Jim Hirstein, Secy P.O. Box 4072 -
Missoula, MT 59806-4072
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