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Name: ____________________________________________ Age: ____________
Address: __________________________________________________________
City: __________________________________ State: _______ Zip: ___________
Country: ________________________ Occupation: ________________________
Phone: (______) __________________ E-Mail: ___________________________
Collecting Interests: _________________________________________________
Annual Dues: Domestic - $15.00 ________ International (airmail) - $23.00 _______
Membership#: APS __________ ATA __________ Other:_____________________
Do you have any special abilities that might help us? (ie. willing to write articles, translate philatelic or thematic text from languages other than English into English for OWASU members?) _______________________________________________
Do you mind sharing your name, address or e-mail address with members? ______
Signature: _________________________________ Date: ___________________ |