Print This Application (COURIER 10 cpi)

Last Name :________________________      Year of birth:_________________
First Name:_________________________     Age this year:_________________
   Address:_________________________          Religion:_________________
          :_________________________        Occupation:_________________
      City:_________________________	     [ ] Male    [ ] Female
     State:_________________________         [ ] Single  [ ] Married
   Country:______________ Postal Code:___________Email Address:_________
Correspondance Preferred  [] Male   [] Female   [] Both
In which languages do you wish to correspond:
ENGLISH Plus  2[]French    3[]German     4[]Chinese  5[]Italian 
              6[]Japanese  7[]Portuguese 8[]Russian  9[]Spanish
Have you ever been a member of our club?  [ ] Yes [ ] No
How or where did you hear about us?____________________________________
Which Items in general interest you?
 1[]Art                 2[]Animals    3[]Athletics           4[]Boating      
 5[]Business            6[]Camping    7[]Cinema              8[]Computers
 9[]Crafts             10[]Dancing   11[]Exchange Vacations 12[]Fishing
13[]Frank Discussion   14[]Games     15[]History            16[]Liturature
17[]Languages          18[]Music     19[]Photography        20[]Poetry
21[]Reading            22[]Science   23[]Sport              24[]Theatre
Select at least 2 Regions in which you want to have PenFriends
  Region 1 [] North America	        Region 7  [] Middle East
  Region 2 [] Central America		Region 8  [] Southern Asia
  Region 3 [] South America		Region 9  [] East Asia
  Region 4 [] United Kingdom		Region 10 [] Africa
  Region 5 [] Western Europe		Region 11 [] Australia & Pacific
  Region 6 [] Eastern Europe		ALL       [] All Regions
[] P1 - One Person....Aged (6-98)	Fees may be paid by cash, U.S. Check,
        $20.00 U.S. or 34 IRC **  	Money Order or IRC
  					and should be made payable to: IPF
                                  	Please return this form with fees to:                                    
International PenFriends
PO  BOX  789
CHELAN,  WA  98816-0789

   You will start by recieving a list of 10 PenFriends that you will
write first. Membership lasts one year and during that time your name
will appear on ten other member lists who will write to you first.
Giving you as many as 20 PenFriends who will be in your own age group,
capable of writing at least one language you have in common and 
have similar interests.

** (IRC) = INTERNATIONAL REPLY COUPON. Available at any Post Office / Type CN 01


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