Philippines Incorporation 1974 — APS Affiliate #54 MEMBERSHIP APPLICATION

Name:
Mailing Address:
#Phone:
E-Mail Address: (required for courtesy reply)
I collect these Philippine areas:
Membership Dues: (Click one)	United States	Overseas (via airmail)
	*Regular (hard copy) = $40	= $60
	*Contributing (hard copy) = $50	= $70
	*Sustaining (hard copy) = $60	= $75
	E-version (electronic) Only = $10
*#NOTE:	Do you wish to receive an electronic PDF copy of the Philippine Philatelic Journal in addition to the mailed hard copy?         Yes     No [If yes, you MUST list an email above.]
Member Status:	I am applying as a NEW member   I am a member, this is a RENEWAL
Date:
*Remarks:
Payment Options: (Click one)	Click the SEND button below and then enclose a check or money order and mail to the address below (1) Click the SEND button below and THEN (2) pay online.  Our PayPal section uses PayPal or Visa, MasterCard, American Express, and Discover credit cards.
#Optional	After sending this form you will be returned to our Membership Page.  You may use this page to pay your dues online.

For questions or equerries contact:

IPPS Coordinator and Acting Secretary/Treasurer
Attn: James Larot
4990 Bayleaf Ct.
Martinez, CA 94553

E-mail:  jimbert_larot@yahoo.com
Phone:  (925) 260-5425

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