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United States Stamp Society
Application for Membership
Mail to: Executive Secretary, P.O. Box 6634, Katy, TX  77491-6634

I hereby apply for membership in the United States Stamp Society and have enclosed payment for my initiation fee, dues and a subscription to The United States Specialist based on the remittance schedule below.  I understand that the full amount of my remittance will be returned to me if my application is not accepted.

Name  ____________________________________ Date of Birth __________________

Address _______________________________________________________________________

City __________________________     State __________   Zip + 4 _________________

Email _______________________________________________________________________

References
Note: References are not required of current members of the American Philatelic Society or the American Stamp Dealers Association. Only a membership number is needed. Others should provide a full name and address of a personal and a philatelic reference.
APS No. ____________ ASDA No. ____________

Personal Reference ________________________________________________________

Address ___________________________________________________________________

Philatelic Reference ________________________________________________________

Address ___________________________________________________________________

Signature of Applicant _________________________________   Date  _______________

Signature of Sponsor* _________________________________   USSS #  _______________
* If requested, the Executive Secretary may at his option sign as your sponsor.

Remittance Schedule
Amounts include dues, initiation fee and a subscription to the U.S. Specialist.  Postage prepaid for USA addresses only; North America add $8.00, other countries $30.00 in U.S. funds.  Make checks payable to the U.S.S.S.

Jan-Feb-Mar
Apr-May-June
July-Aug-Sept
Oct-Nov-Dec
$25.00
$20.00
$15.00
$30.00*
Amount Enclosed: ___________
*Includes 12 months of the following year.
revised 08-Nov-2007