| ___________________________________ |
|
___________________________________ |
| Last
Name |
|
First
Name, Initial |
| ___________________________________ |
|
|
| Street
with Apt. Number or P.O. Box |
|
|
| ___________________________________ |
|
|
| ___________________________________ |
|
|
| ___________________________________ |
___________ |
___________________________________ |
| City |
State |
Zip
or Postal Code |
| ___________________________________ |
|
|
| Country |
|
___________________________________ |
| ___________________________________ |
|
E-Mail |
| Occupation |
|
|
| ___________________________________ |
|
Type
of mailing desired (check all that apply): . . . |
| ___________________________________ |
|
|
| Philatelic
References |
|
| _____ |
ICN
sent
surface printed matter rate to U.S., Canada or any other country
US$
22.00 |
|
| ___________________________________ |
|
| _____ |
ICN
sent via airmail to Central or South America or Europe US$
32.00 |
|
| Sponsor |
|
| _____ |
ICN
sent via airmail to Asia, Africa, Australia, New Zealand, Russia,
CIS countries US$37.00 |
|
| Membership
to begin in 20_____ |
|
| _____ |
ICN
on
CD ROM / Volumes 1-39 (in addition to annual dues)
US$85.00, ppd. |
|
Please make
all checks payable to the AMERICAN SOCIETY
OF POLAR PHILATELISTS
|
| AMOUNT
ENCLOSED: US $ ___________. Please print and submit this application
to the Treasurer: |