Print (CNTRL P) the following; complete the form and mail it to the address at the end:


APPLICATION FOR MEMBERSHIP TO THE INLAND EMPIRE PHILATELIC SOCIETY (IEPS)

I/WE with to apply for membership in the I.E.P.S. I/WE Agree to abide by the rules and regulations of the club. Enclosed is the current year dues (Associate (18 and under) $5.00; Individual $10.00 and Family $15.00). Check may be made payable to IEPS.

NAME(S): ________________________________________

STREET: ________________________________________

CITY: ________________ STATE: _____________ ZIP ________

HOME PHONE: _____________ WORK PLACE: ________________ PHONE: ____________

e-mail address: ____________________

COLLECTING INTERESTS: _________________________________________

APS MEMBER: Y / N APS Number (If applicable): _____________

ATA MEMBER: Y / N

OTHER STAMP CLUB AFFILATION: _____________________________________

REFERENCES:

1. __________________________________ Phone: __________

2. __________________________________ Phone: __________


____________________________________ DATE: ___________________
SIGNATURE:

MAIL TO:

IEPS
PO Box 3731
Spokane WA 99220


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For Office Use: Accepted ___/___/___ PRES ___SEC ___ TRES ___

DUES RECEIVED (DATE): __________