Central States Numismatic Society

Membership Application Form

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YES, I want to be part of the Central States Numismatic Society!

Name _____________________________________________________

Address ___________________________________________________

City _________________________State___________Zip____________

Country ____________________________ Birthdate _______________ (If Under 18)

Type of Membership: Adult __ Club __ Junior __ (Check One)

  ___Enclosed is $250.00 (US funds) for a life membership (Not Available to Foreign Residents)
  ___Enclosed is $15.00 (US funds) for a 1 year membership. (Adults and Clubs)
  ___Enclosed is $5.00 (US funds) for 1 year junior membership


Central States Numismatic Society
Patricia Foley - CSNS Secretary
PO Box 210710 Milwaukee, WI 53221

E-mail Address (optional)    _______________________________________________

I herewith make application for membership in the Central States Numismatic Society,

Signature of Applicant________________________________________Date_________

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