Southeastern Matchcover Club Membership Application Name(s):_________________________ Telephone No. ( )___________ Address: ______________________________________________________ City: _______________________ State: __________ Zip: _____________ E-mail Address: __________________ The following information is requested so we may have an idea of each members categories to be included in the annual membership list. General Collector: _____(Yes) _____(No). Mail Trader:_____(Yes) _____(No) Favorite Categories: 1.___________________ 2.___________________ 3.__________________ 4.___________________ 5.___________________ 6.__________________ 7. ___________________8.___________________ 9.__________________   First year $1.00 registration fee in addition to the annual dues. Annual dues are $5.00 individual; $6.50 family (Please submit all names). I enclose payment of $________ for ____(individual) ____(family) membership. Birthdate: Mo._________ Day________ Signature ___________________________ Sponsored by_________________________   Return the completed form and dues payable to: Bill Hayes, Treasurer/Membership Secretary 13553 San Rafael Dr. Largo, FL 33774 Tel: 727-470-9148

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