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MAPS MEMBERSHIP APPLICATION

Please print this on your printer so you can fill it out and mail it to us.
Please print or type clearly so we can read it.

Name:

 

Date:

 

Spouse's name:

 

Phone no.:

 

Street address 1:

 

Fax no.:

 

Street address 2:

 

City:

 

State:

 

Postal code:

 

Country:

 

E-Mail:

 

Web page:

 

How did you first learn about MAPS?
 

How long (in years) have you been collecting antique phonographs, music boxes, and/or records?
_____

Are you a (check all that apply):

O -- Collector O -- Archivist O -- Researcher O -- Dealer

Tell us a little about yourself: (Collecting interest, i.e., opera, early jazz, Victrolas, Edison, etc., other hobbies)

 
 
 
 

Would you like to be listed in our next printed membership directory?
O -- YES O -- NO

Would you like to be listed in the membership directory on the World Wide Web? If so, add a few lines about yourself for the listing.
O -- YES O -- NO

 
 
 
 

www.michiganantiquephonographsociety.org/MAPSmember.html

Mail completed form with your payment (made payable to MAPS) to:

MAPS
60 Central Street
Battle Creek, MI 49017-3704
U.S.A.

Include payment of the appropriate calendar year's dues:

As a condition for membership in the Michigan Antique Phonograph Society, you must complete the membership form. Your application for membership will be voted on by members present at the first business meeting after your completed form is received.

Because we have an all-volunteer staff that processes your membership application, generates mailing labels, keeps records, mails out In The Groove each month, etc., it simplifies their work if all dues fall due each year on January 1st. All membership accounts zero out on January 1st and the full year's dues are due in full at that time. The January issue will automatically be sent to all members while the last minute renewals are registered.

Check here
O
 1. I enclose the full year's dues to receive all back issues of In The Groove for this year.
O
 2. Please begin my membership with the current issue of In The Groove. I enclose $2.10 for each month remaining through December.
O
 3. Please hold my membership until the beginning of the next year.
O
 4. Please begin my membership with the current issue of In The Groove and donate any excess credit to publication of the magazine and directory.

*** NOTE: Failure to check a box will result in the last option.

Applicant's Signature: _____________________

Date (month/day/year): ______ / _______ / 200__

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This page maintained by Pogo@LRBCG.COM and was last updated on November 1, 2005.