Assigned Member Number _______

Application for Membership in the Pennsylvania Postal History Society <www.PaPHS.org>

I hereby apply for ( ) admission ( ) reinstatement (give former member number_____) to the Pennsylvania Postal History Society. I agree to be bound by all rules and regulations of the Society as expressed in its bylaws and the Membership Understandings. I enclose one year’s dues @ $22.50. After July 1, dues for the balance of the year is $10.00.

Full Name ____________________________________________________________________

Full Address___________________________________________________________________

_____________________________________________________________________________

Home Phone _________________________ Business Phone ____________________________

E-Mail ____________________________

Occupation _________________________ Employer _________________________________

Other Society Memberships ______________________________________________________

____________________________________________________________________________

PA Postal History Collecting Interests ______________________________________________

____________________________________________________________________________

Philatelic References (1) _________________________________________________________

(2) _________________________________________________________________________

Applicant’s Signature __________________________________________ Date ____________

PPHS Proposer _______________________________________________________________

Send completed application and dues to:

Norman Shachat
PPHS Secretary
382 Tall Meadow Lane
Yardley, PA 19067