Central States Numismatic Society

Membership Application Form


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 $200.00 (US funds) for a life membership (Not Available to Foreign Residents)
  ___Enclosed is $10.00 (US funds) for a 1 year membership. (Adults and Clubs)
  ___Enclosed is $25.00 (US funds) for a 1 year membership. (Adults and Clubs outside of US)
  ___Enclosed is $3.00 (US funds) for 1 year junior membership


RETURN APPLICATION WITH PAYMENT TO:

Central States Numismatic Society
P.O. Box 841
Logansport, IN 46947


E-mail Address (optional)    _______________________________________________

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

Signature of Applicant________________________________________Date_________



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