CUBAN PHILATELIC SOCIETY
of AMERICA, Inc
P.O.Box 141656
Coral Gables,Fl 33114-1656
I hereby request membership in the Cuban Philatelic
Society of America.
Name: _________________________________________________________________________
Address: _______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Home Telephone: ______________________ Work Telephone: __________________________
e-mail address: _______________________________ FAX: _____________________________
Philatelic interests: ______________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Membership in other philatelic societies: _____________________________________________
______________________________________________________________________________
______________________________________________________________________________
Other philatelic references: ________________________________________________________
_______________________________________________________________________________
Sponsored by: Miguel A De Dios
CPSA Membership No. 256
I enclose the U.S. $5.00 application fee together with the corresponding
annual membership fee:
(Check payable to: CUBAN PHILATELIC SOCIETY of
AMERICA, Inc)
Regular U.S.:
$15.00 $_________
Regular Outside the U.S.: $30.00
_________
Sustaining:
$50.00 _________
Life (U.S./Other) $300.00/600.00
_________
Application fee:
$5.00
5.00
Total:
$_________
Signature: ____________________________________________ Date: ___________________
Membership number assigned to the applicant by the CPSA: _____________