Print out this page and mail to: Norman Shufrin, 11 Montgomery Drive, Framingham, MA 01701

MEMBERSHIP APPLICATION

Date: ______________                                                                         MEMBERSHIP NO. _______

To: Waltham Stamp Club                                                                      

I hereby apply for admission to membership in the Waltham Stamp Club.
The annual dues of $12.00 are remitted herewith as prescribed by Club bylaws.
This amount will be refunded if my application is not accepted.

Name __________________________________

Tel. # _________________

Street __________________________________ E-mail ____________________________

City ________________ State ___________ Zip ________

Occupation _______________________________________

Philatelic specialties (what I collect): _____________________________________________________

A.P.S. # ___________________________

Membership in other Philatelic Societies ____________________________________________________________________________________

Why I'm interested in joining the Waltham Stamp Club
_____________________________________________________________________________________

_____________________________________________________________________________________

Applicant's Signature _______________________________________

I hereby endorse the above application and propose _______________________________for membership.

Proposed by ____________________________________ Membership # ____________________

1st Reading ___________________ 20____ 2nd Reading __________________________20___

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