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MEMBERSHIP APPLICATION

Please complete using a computer or word processor
(handwritten documents are not acceptable)

Family and first names:
Nationality:
Full Postal Address:
Phone number:
Fax number:
Mobile phone:
E-mail Address:
Website:

Spoken and written languages:

RDP: YES / NO

Member of the following PHILATELIC organizations (and your title): e.g. RPSL (Fellow), Académie de Paris (m.c.), AEP (treasurer), etc…:

Other positions and responsibilities in the philatelic sector:

Principal collections and areas of interest:

Philatelic rewards (where and when obtained):

Publications:

Attached: Reports submitted by the Proposer and Seconder.