ISASC Membership Application
(Print this form, complete it and send along with dues to address listed at the bottom)
(please type or print)

Name________________________ Spouse's Name________________________

Address:   _________________________________________________________
_________________________________________________________________

Occupation (optional) ________________________________
Telephone _________________________________________

FAX _____________________________________________ 
Email Address______________________________________

Approximate number of scales in your collection:________    Describe in general terms: _{________________________________________________________________________________}
____________________________________________________________________

Approximate number of weights in your collection:_______     Describe in general terms:
____________________________________________________________________
____________________________________________________________________

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

Please indicate where you heard about the ISASC organization. Check all that apply.

ISASC Website	Antique Dealer	Other (Specify Below)
ISASC Member	ISASC Rack Card	______________________

Signature:_______________________________

Send To:

Kurt Beyreis
ISASC Membership Chairman
1730 Van Buren Road
Maurertown, VA 22644