PPD Star Ratings: Application Form

(Please help avoid mistakes by printing neatly or typing.)
Monochrome Prints - Mail to Tom Hady, APSA, PPSA, 6719 Bellamy Ave., Springfield, VA 22152, USA

Color Prints - Mail to Stuart Bacon, 1320 Benito Avenue, Burlingame, CA 94010-5626, USA

(This form is optional. If you want to include the information in a letter, that’s fine.)

1. Name (exactly as it should appear in the certificate, including PSA recognitions) and mailing address:

Please Print__________________________

e-mail address:_________________________________________________________________

Having your email address can speed things up if there are questions.

2. Are you applying for a star in:

Monochrome Prints? ____ Large or _____Small? | Color Prints? ____ Large or _____Small?

3. What Star? ______________

4. How many new Acceptances?________

On a separate sheet of paper, list new acceptances, showing year, exhibition and title. Sort by year and exhibition and number consecutively.

5. Judging credits (see instructions for number, no new titles):

Year_____Salon______________ Number __; Year_____ Salon________________Number_______

6. How many new titles?________ On a separate sheet of paper, list new titles with one example of a salon (and year) that accepted. Number consecutively.

7. Remember to enclose fee ($8.00 per star award, payable by check to PSA on U. S. bank, cash or the optional credit card charge authorization) and a photocopy of your PSA membership card.

Payment by Credit Card (print and fill out this form or download a credit card form in pdf)

Credit Card Type - Visa _____ Master Card______

Credit Card Number _______________________________

Expiration Date _________________

Print Name of Credit Card Holder: ____________________

Signature of Credit Card Holder:_______________________, Date_____________

Authorizing a PSA Total Charge of $__________ In payment of fees for Pictorial Print Division Star Rating.

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