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Date__________________________________20__________
Print Name________________________________________
Address___________________________________________
City________________________State_____Zip__________
Email Address______________________________________
Occupation________________________________________
Collecting Interests_________________________________
Are You A Collector?_______Dealer?______Both?_______
Philatelic Organizations To Which You Belong:__________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Signature Of Applicant_______________________________
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Mail this completed application along with your check for the appropriate amount made out to The USCC to:
Roger Rhoads, Secretary - USCC
6160 Brownstone Ct
Mentor, OH 44060 USA
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