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 $250.00 (US funds) for a individual life Membership (Not Available to Foreign Residents)
  ___Enclosed is $350.00 (US funds) for a club life Membership
  ___Enclosed is $15.00 (US funds) for a 1 year Regular Membership. (Adults)
  ___Enclosed is $25.00 (US funds) for a 1 year Regular Foreign Membership. (Adults and Clubs outside of US)
  ___Enclosed is $25.00 (US funds) for a 1 year US Club Membership.
  ___Enclosed is 10.00 (US funds) for 1 year Associate Membership (Associate membership does not receive "The Centinel" and must be a household member of a Regular member.)
  ___Enclosed is $5.00 (US funds) for 1 year Junior Membership


RETURN APPLICATION WITH PAYMENT TO:

Central States Numismatic Society
c/o Secretary Patricia Foley
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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