NEW MEMBER APPLICATION FORM

The HPS Register data is for the exclusive use of the Administrative Council of the Society.

(TITLE), SURNAME, NAME:

OCCUPATION: YEAR OF BIRTH:

RESIDENCE ADDRESS:

ADDRESS FOR RECEIVING Philotelia:

HOME TEL. no.: WORK TEL. no.:

OTHER TEL. nos: MOBILE TEL. no.:

FAX: e-MAIL:

REFERENCES:

I wish my name and residence address to be furnished to third parties in order to receive literature of philotelic content. YES NO

COMMENTS:

Before submitting, please make sure data is correct and complete.