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____ I am a former member, APCS # ________ (re-instatement) Name: ___________________________________________________________ Address: ________________________________________________________ City: _________________________ State: _________________________ Zip/Postal Code: ______________________ Country: _______________ Email: ______________________________________ Personal Web Site URL: __________________________________________ How did you first learn of the American Pencil Collectors Society? Please tell us about your pencil collection and particular collecting interests (how long have you been collecting, etc.): Please send this completed form to our secretary: Aaron Bartholmey 18 N. Maple St. Apt 4 Colfax, IA 50054 USA Please include dues (must be US negotiable): ____ $10.00 (US) ____ $18.00 (elsewhere)