This form should be used by an Applicant or an Existing Member of the National Philatelic Society
who wishes to nominate one or more persons who reside at his/her address to be
a Family Member of the National Philatelic Society.

I, (enter name and address)
 ________________________________________________________________________________________

_______________________________________________________________________________________   am
 * currently applying to Join the National Philatelic Society/ * an existing member of the National Philatelic Society                                       *please delete as appropriate
and wish to apply for Family Membership for the following who reside at my address (please enter names of Family members). 

and enclose my cheque for £10 (In the case of new members this payment may be combined with the cheque accompanying the Application Form).

___________________________________________(signed) ________________________(date)

Each new Family Member should complete and sign the section below:

If this application is accepted I agree to abide by the Rules of the National Philatelic Society and to the contact details that I give to the Society’s Membership Secretary (now or in the future) being used for the running of the Society including the circulation of the Packet, and for contacting me.

                FULL NAME & TITLE                                DATE OF BIRTH (IF UNDER 18)                                                   SIGNATURE