Fillable COUNTRY POSTAL CODE

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NAME: ADDRESS: CITY: STATE/PROV: COUNTRY: POSTAL CODE: PHONE: EMAIL: WEB SITE: OCCUPATION: GENDER: DATE BIRTH: / / MARITAL STATUS: PLACE OF BIRTH (CITY/COUNTRY): LANGUAGES: I COLLECT: LITTLE AD (less than 30 words): I REQUEST: ( ) Subscription FILACAP 4 issues + 4 little ads: US$ 20 / 20 IRCs / 20. ( ) One Little Ad: US$ 5 / 5 IRCs / 5. ( ) Two Little Ads: US$ 10 / 10 IRCs / 10. Issues in March, June, September...
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