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ISASC Membership Application
(please type or print) 
Full Name_________________________ Spouse's First Name___________________
Mailing 
Address: ____________________________________


         ____________________________________


         ____________________________________


Occupation __________________________________


Home Telephone ____________________ Business Telephone _________________


(Please circle the number above that you'd prefer listed.)
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Number of scales in your collection:___________ Describe in general terms:

__________________________________________________________________________

__________________________________________________________________________



Number of weights in your collection:__________ Describe in general terms:

__________________________________________________________________________

__________________________________________________________________________



If you are not a collector, describe the nature of your interest:

__________________________________________________________________________

__________________________________________________________________________

Please enroll me as an  ACTIVE  |  ASSOCIATE  (cross out one)
member of ISASC. Enclosed is payment to cover my dues for the current year.

signature:_______________________________

Mail to:  Bob Stein    300 West Adams, Suite 821,    Chicago, IL 60606   USA
Printed from Collector Online - http://www.collectoronline.com/clubs/ISASC/