Title
First Name
Surname
Date of Birth

Mailing Address

House Name/Number
Street
City/Town
Country
Post Code
Telephone(incl. International Code)
Telefax(incl. International Code)
Email (request cannot be processed without this)
I wish to receive correspondence from the Society by (choose one):	Ordinary Mail E-mail

Important note: The Society's Journal and Annual Financial Statements are sent by mail.

Interests and Associations

Collecting Interest: (enter short description)

Membership in other Philatelic Associations (Societies):

I am a Member in good standing of other Philatelic Associations (Societies).
I have no objection that the Malta Philatelic Society contacts the listed Association(s) in my regard should it deem fit to do so.
(enter name and membership number) 
I am a Philatelic Dealer and I am also a Member in good standing of the following Philatelic Traders Association(s). I have no objection that the Malta Philatelic Society contacts the listed Association(s) in my regard should it deem fit to do so.
(enter name and membership number) 

"I have verified the above statements and hereby apply for admission as a Member of the Malta Philatelic Society."