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(Rate Schedule
listed below application)*
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 Katherine H. Foster PSS No. 6793
Please print, complete and mail with your application
dues to: Jim Hirstein, Secy
PO BOX 4072, MISSOULA,
MT 59806-4072
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