Name                        ________________________________

Street or P.O. Box    ________________________________

City                            ________________________________

State or Country ____________   Zip or Postal Code ________

Telephone Number (        ) _________________

E-mail address        _________________________

Philatelic References
 

Are you under 21 years of age?     Yes     No

Where did you hear of A.H.P.S.?
 

If you were recruited by an A.H.P.S. member, please give his or her name
 

Swiss or Liechtenstein collecting interests
 

Are you interested in writing for Tell?      Yes       No
If yes, on what subjects?
 

Have you ever been expelled from or denied admission to any philatelic organization?     Yes    No

I certify that the above information is true and I promise to abide by the by-laws of the A.H.P.S. if I become a member. (Parent or guardian must sign if you are a minor.)

Signature ___________________________     Date  _____________

Enclosed check, made payable to A.H.P.S., is for:

(circle one)             USA       Canada and Mexico       Overseas          Mail to:

Annual Dues:       $24.00               $26.00                       $31.00                 Richard T. Hall, AHPS Secretary
                                                                                                                     P.O. Box 15053
Life Membership: $400                   $500                         $600                   Asheville, NC 28813