MEMBERSHIP APPLICATION

Please feel free to print out this application, fill it out and mail with your dues payment to our Membership Chairman. A PDF Version of this application is also available.


CONFEDERATE STAMP ALLIANCE APPLICATION

Please complete form and mail to: 

Col. Larry Baum
316 W. Calhoun St.
Sumter, SC 29150

Date:___________________


I hereby submit my application in the Confederate Stamp Alliance. If elected to membership, I agree to be bound by the Constitution and By-Laws of the Alliance. Membership includes a subscription to The Confederate Philatelist, published quarterly.

 NAME:___________________________________

ADDRESS:________________________________

CITY:__________________  STATE: _________   

ZIP:____________ COUNTRY:_______________

EMAIL ADDRESS:________________________

OCCUPATION:___________________________

Home Phone:_____________Work:____________

CSA Collecting Interests:_____________________

Under 18?       ______YES  _____ NO

Collector?       ______YES ______ NO

Dealer?           ______YES ______ NO

Other Philatelic Memberships:

APS # __________USSS # __________

USPCS #________ASDA # _________

OTHERS:________________________

Previous CSA Member:        ___YES ___NO  

If yes,  previous Member #_____________

Mailing addresses of new members are published in The Confederate Philatelist as required by our By-Laws. If you do not wish to have your Email address published, please check here.  ______

PLEASE ALLOW 4 – 6 WEEKS FOR THE APPLICATION TO BE PROCESSED. PLEASE REMIT AMOUNT INDICATED BELOW WITH YOUR APPLICATION.

 

 Active (age 18 and over)

Junior (under age 18)

 Dec, Jan, Feb

______$32.00

______$18.00

 Mar, Apr, May

_____$24.00

_____$15.00

 Jun, Jul, Aug

______$20.00

______$13.00

Sep, Oct, Nov*

 _____$34.00

_____$20.00

* Last quarter application fee includes dues for the following year.

NOTE: Applicants residing outside the United States, Canada or Mexico MUST add $24.00 to the application schedule.  PAYMENT MUST BE IN U. S. FUNDS DRAWN ON A U. S. BANK OR INTERNATIONAL MONEY ORDER, made payable to the Confederate Stamp Alliance.

 


REFERENCES:

Each applicant MUST provide character references below. Full names, addresses and numbers should be given as all references will be contacted as required by our By-Laws. If the application is for a Junior Member, the GUARANTOR must provide references.

Name and address of TWO character references (philatelic preferred, but not required):

NAME:________________________________

ADDRESS:_____________________________

CITY:__________________STATE:_________

ZIP:___________COUNTRY:______________

EMAIL:___________________

Home Phone: _______________

Work Phone:________________

 

 

NAME:________________________________

ADDRESS:_____________________________

CITY:__________________STATE:_________

ZIP:___________COUNTRY:______________

EMAIL:____________________

Home Phone: _______________

Work Phone:________________


If applicant is under age 18, please provide name and address of Guarantor:

NAME:________________________________

ADDRESS:_____________________________

CITY:__________________STATE:_________

ZIP:___________COUNTRY:______________

EMAIL:____________________

Home Phone: _______________

Work Phone:________________

Relation To Applicant:__________

 

Guarantor shall be responsible for all debts incurred by Applicant to the Alliance or any of its members until Applicant reaches eighteen years of age.

 I agree to the conditions stated on this application and authorize the above-stated parties to release financial or character reference information on myself to the Confederate Stamp Alliance.

Signature of Applicant:_____________________________________________

Signature of Guarantor (if applicable):________________________________________

I hereby endorse the above Applicant and propose for membership in the Confederate Stamp Alliance (Proposer must not be one of the references above).

Proposed by:________________________________________ CSA # __________
Rev. 11/12