Application For Membership in the
Precancel Stamp Society, Inc.

Mail Application to:
James Hirstein, Secretary
P.O. Box 4072
Missoula, MT 59806-4072

Date:

I, hereby make application 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:

Town: State: Zip:

Date of Birth: Occupation:

Employer or Business Connection:

Collecting Interests:

Membership in Other Philatelic Societies:

Do you wish to exchange with other members?

If applicant is over 17 years of age, names and full addresses of two references (other than proposer) must be furnished.
References:

1. Name:
   Address:
   
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 myself 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: Relation to Applicant:

Address:

Town: State: Zip:

Proposed by: PSS No.

Schedule of Remittances

* Includes dues for subsequent fiscal year, September 1 to August 31.

Foreign checks, including Canadian, cannot be accepted unless drawn on a US Bank, and payable in US dollars.
Make all remittances by check or money order payable to: PRECANCEL STAMP SOCIETY, INC.