The Membership Secretary
13 Midvale Avenue
North Balwyn
Victoria, Australia 3104

To the Committee,
I wish to apply for ADULT/JUNIOR/ASSOCIATE membership of the A.M.C.C.S. and, if accepted to abide by the rules of the Society.

Name............................................................... Mr/Mrs/Miss Address: Street........................................................................... Town........................................................................... State............................................Postcode.................. Country, (If not Australia) ............................................

BLOCK LETTERS PLEASE

The following information is required in order that member's phillumenic details and interests can be included in the membership lists.
I collect (Tick if applies)

Labels [ ]	Packet Labels [ ]
Skillets [ ]	Booklets [ ]	Hardware [ ]

No. of items in collection: Labels.................. Booklets..................
I specialise in (e.g. country, theme, etc.) ......................................
Are you willing to exchange with other members? Yes [ ] No [ ]
I am able to correspond in the following languages: .........................
.........................................................................................

I enclose $................. in payment of my membership fee

If you are applying for membership as a Junior, please give your date of birth and request your parent to sign this form.

Date of Birth.........................................
Signature............................................... Date............................

If you require a Society Badge, please enclose an extra $2.00,
and tick here [ ]