CROATIAN PHILATELIC SOCIETY
                           P.O. Box 696 
                	Fritch, Texas 79036-0696


Name_______________________________________ Age_____________________


Street or Box_______________________________________________________

                            State or
City_______________________ Province ___________ Zip________________

                     Occupation &
Country_____________ Employer    ___________________________________


Date and place of birth ____________________________________________


Do you wish to be listed in the Directory? ___ Are you a Dealer?____


I collect:

Stamps:_____ Coins:_____ Currency:_____ Medals:_____


Bosnia and Hercegovina (1878-1918)                        __________

Croatia (1918), Croatia SHS, Bosnia and Hercegovnia SHS   __________

Independent State of Croatia (1941-1945)                  __________

Republic of Croatia (1991-present)                        __________

Yugoslavia                                                __________

Albania_______                  Austria________

Bulgaria______                  Fiume__________

Hungary_______                  Macedonia______

Italy_________                  Montenegro_____

Romania_______                  Serbia (1866-1920)_____

Serbia SHS, etc._________       Slovenia _____

Ljubljana (Laibach) _____       Triest (Zones A & B)_____

Istria & the Slovene Coast _____ Zara (Zadar) _____

Baranya _____

Other interests: __________________________________________________

___________________________________________________________________


Other Stamp and Coin Club Memberships, incl. # ____________________

___________________________________________________________________

___________________________________________________________________


The fiscal year ends October 31st.  Dues are $20 per year for
all countries.  Please remit dues with application per table
bellow:

November-January $20;  February-April $28;  May-July $25;

August-October $22.

By remitting the correct amount, dues will be paid to 31 October
19__.  Your membership fee includes a subscription to 
THE TRUMPETER, the Society's quarterly journal.  Please make
remittance payable to the CROATIAN PHILATELIC SOCIETY.  Dues
are payable in U.S. funds.

Applicant's signature_________________________________ Date_________
***********************FOR CPS USE**********************************

Membership Number________ Date _________ Rcmd By ___________________