ffiSA}{ JOSE STAMP CLTEW Apptication for membership

City. State_ Zip

Accepted

PreeldenUSecretary

I hereby apply for membership in the San Jose Stamp Club, and agree to be bound by it's

Constitution and By-Laws; and hereby tender $_in payment for

-

months.

Dues are $12.00 per year and juniors are $6.00 per year prorated monthly.

PLEASE READ CAREFULLY AND ryPE OR PRINT . PLEASE. DO NOT USE PENCIL

Name Home phone

HomeAddress

BusinessAddress Phone

E-mail FAX

Please inform the Secretary of any changes in the above information.

tfttttftttotooottPerconal Data

Name as you want it to appear on roster, etc.

Additionalfamily members (indicate relationship) joining at this time (No additional charge.):

1. 2.

4.3.

Philatelic societies of which you are a member: APS tr ATA tr

Stamp collecting interests:

Opportunities for service: Your help is needed to keep the club functioning effectively and to helpmake it as interesting and helpful as possible to the members. ln what areas are you interestedand/or qualified in helping? Please indicate:

1. Filatelic Fiesta Committee 2. Serve as an officer 3. Publicity & promotion

4. Reception (sign in table) 5. Newsletter (editorial) 6. Program

7. Serve on a committee 8. Help with youth & novices 9. Other

Comments

Signed: Date

Mailwith fees to San Jose Stamp Club, P.O. Box 730993, San Jose, CA 95173; or bring to meeting.See our website at http://filatelicfiesta.org for additional information. Thank you.Revised Soptcmber 2009