Application Form For The Perfins Club, Inc

________________________________________________________
Last Name                                        First Name                    Initial

________________________________________________________
Street Address or P.O. Box

________________________________________________________
City                                State        Zip                        Country

________________________________________________________
e-mail Address

                    Two References or Major Societies

________________________________________________________
                                                                        Membership Number

________________________________________________________
                                                                        Membership Number

Perfin Interest (country/topic)_____________________________

Beginner_____        Intermediate_____        Advanced_____

I HERBY SUBMIT DUES PAYMENT OF $_____ AND APPLICATION
FORM FOR MEMBERSHIP IN THE PERFINS CLUB, INC.

Signature_________________________________  Date_________

Proposed By: ____Michael Hynes __________________________

Make Check or Money Order (U.S. Funds ONLY) Payable to
The Perfins Club, Inc.  Mail Completed Application to:

Ken Rehfeld, Secretary
The Perfins Club
P.O. Box  125
Spokane Valley, WA  99016-0125
U.S.A.