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Membership Application
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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)