APPLICATION for MEMBERSHIP  - 
POSTAL STATIONERY SOCIETY of AUSTRALIA

[Current subscription for one year - Australia  $A35,  NZ $A40, overseas  $A50]

I apply for membership of  the Postal Stationery Society of Australia:

Surname/Family Name:                                                                     Given Names:

__________________________________________             _______________________________________

Address:   _______________________________________________________________________________

_______________________________________________________________________________________

City: ____________________________ State ____________________________ Postcode:   _____________

Contact information: Tel (h):_______________________________ (m): ______________________________

Email address: ____________________________________________________________________________

Interests in Postal Stationery collecting: ________________________________________________________

________________________________________________________________________________________

Remittance:    Enclosed is my subscription for the year/s 20_____ / 20_____      $A  __________
[cheques to be made payable to ‘Postal Stationery Society of Australia’].

Credit card details:

Card No: __________________________________ Security No ___________ Expiry: ___________
                                                                                          (last 3 digits on back)

Name on card (please print): _________________________________________________________

Signed: _____________________________________________ Date: _______________

SEND this form with your payment to: Treasurer PSSA, PO Box 2296, KEPERRA, QLD 4054 AUSTRALIA