APPLICATION FOR EXPERTIZATION SERVICES

To the Expertization Committee of the Society for Czechoslovak Philately, Inc.:

I have read and fully agree to the RULES AND PROCEDURES GOVERNING EXAMINATION OF PHILATELIC ITEMS BY THE EXPERTIZATION COMMITTEE OF THE SOCIETY FOR CZECHOSLOVAK PHILATELY, INC. (Please note especially Article IV B.)

I am the owner of the material to be submitted or have been authorized by ____________________

to submit the material for expertization.

Signature__________________________________ Date___________ Owner's Item #_________

Name(print)____________________________________________ SCP Member #___________

Address___________________________________ State______Zip code________________

Telephone_________________________________e-mail_______________________