Southeastern Matchcover Club Membership Application

Name(s):_________________________ Telephone No. ( )___________
Address: ______________________________________________________
City: _______________________ State: __________ Zip: _____________
E-mail Address: __________________

The following information is requested so we may have an idea of each
members categories to be included in the annual membership list.
General Collector: _____(Yes) _____(No). Mail Trader:_____(Yes) _____(No)
Favorite Categories:
1.___________________ 2.___________________ 3.__________________
4.___________________ 5.___________________ 6.__________________
7. ___________________8.___________________ 9.__________________
First year $1.00 registration fee in addition to the annual dues.
Annual dues are $5.00 individual; $6.50 family (Please submit all names).
I enclose payment of $________ for ____(individual) ____(family) membership.
Birthdate: Mo._________ Day________
Signature ___________________________
Sponsored by_________________________
Return the completed form and dues payable to:
Bill Hayes, Treasurer/Membership Secretary
13553 San Rafael Dr.
Largo, FL 33774
Tel: 727-470-9148

Back to RMS Home Page