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.