Application for Membership to Print Out and Mail
OR
CLICK HERE to Apply for Membership or Renew Membership Online
Date: ______________________
To:
Phil Rhoade, Secretary, 905 E. Oakside Street, South
Bend, IN 46614.
I hereby apply for membership
in the Society for Czechoslovak Philately, Inc. and , if approved, agree
to abide by the Society's By-Laws. (Check one of the following):
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$25.00 for annual dues ~ Regular Membership.
This includes a one-year subscription to the Czechoslovak Specialist. |
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50.00 for annual dues ~ Patron Membership.
This includes a one-year subscription to the Czechoslovak Specialist
and a bound volume of all issues for the subscription year. |
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$3.00 for annual dues ~ Youth Membership. Limited
to persons under 18 years of age (please list Date of Birth) |
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Additional contribution |
Foreign members
residing outside the US, please add:
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$12.00 for delivery (Canada & Mexico Only)
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$20.00 for airmail delivery |
Total enclosed: ____________________
Remit by check or money order
only. DO NOT send cash or stamps.
Name: ___________________________ Age: ______
Street: ____________________________________
Fax: ___________________
City: ___________________________
State: ____________ Zip: ________________
Telephone: __________________________
Email: ____________________________
Collecting Interests: __________________________________________________________
Membership in other societies:
__________________________________________________
___________________________________________________________________________
___________________________________________________________________________
How did you find out about
SCP?: ________________________________________________
Applicant Signature: ____________________________________________
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