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Application for Membership in the Precancel Stamp Society, Inc.

(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

*SCHEDULE OF REMITTANCES - listed amounts include $2.00 as Initiation Fee
and $6.00 per year subscription to the Precancel Forum prorated. Default is electronic delivery. Paper copy by domestic second-class surcharge is $15.00 and domestic first-class in envelope surcharge is $25.00. Canada surcharge is $25.00 and other country surcharge is $35.00. (back to top of application)

DATE OF APPLICATION:

REGULAR

JUNIOR

September 1 to November 30

$17.00

$6.00

December 1 to February 28

$13.25

$5.00

March 1 to May 31

$ 9.50

$4.00

June 1 to August 31

$20.75*

$7.00

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