Jackson Philatelic Society

Jackson Philatelic Society (https://jacksonphilatelicsociety.org )

P. O. Box 16792

Jackson, MS 39236-6792

APS chapter # 831

JPS Jackson Philatelic Society Membership Application

(Please print clearly)

Name (last, first)_____________________________________ Date____________

Names of other Adult Members in the Family (last, first): ________________________________________

Names of Junior Members (less than 18 years in the Family, :with ages in the parenthesis): ______________________________________________________________________________________

In addition to head of family, if members are less than 18 years list their names with their ages in parenthesis: __________ ____________________________________________________________________________

Occupation __________________________

Mailing Address______________________________________________________

City, State____________________________________ Zip Code_______________

Tel. No.: Home_________________ e-mail ________________________________

Membership requested: Individual____ Family____ Children under 18 (number) ____

American Philatelic Society (APS) member? Yes___ No___ If yes, membership No. ______

Other philatelic societies to which you belong _____________________________

_____________________________ ___________________________________

Philatelic interests _____________________________________________________________________

____________________________________________________________________________________

_____________________________________________________________________________________

Signature of this Application by Head of Family _____________________________ Dated ____________

(If Family Membership is requested, provide information above for all adult members on separate forms, for children under 18: only names and age on back of application)

Please, mail completed form and dues payment (yearly Individual: $5; Family: $ 10; children under 18 years: none) to the Jackson Philatelic Society address at the top of this form.

For APS office use only

Date application received___________________ Copy to: ( ) Treasurer

Membership proposed by:___________________ ( ) Secretary

1st reading of Application ___________________ ( ) Newsletter

2nd Reading of Application __________________

Accepted into Membership Yes / No