Name: _________________________________

Address: _______________________________

_______________________________

_______________________________

_______________________________

Date of Birth: ______________ Age: _________

Collecting Interests: _______________________

______________________________________

______________________________________

______________________________________

 Signature: ______________________________

Date: ___________________

Please remember to enclose your $10-00 Subscription

and Post to:

Fun Philately Stamp Club

Only applications from New Zealand residents will be accepted.