I hereby make application for membership in the Missouri Numismatic Society subject to the by-laws of said Society.



Mr./Mrs./Miss:________________________________________________________________________                                                                              Name (please print)


____________________________________ __________________________ __________ __________

             Street Address                                                  City                                           State                 Zip



Spouse: ____________________________________________________________________________



Children: ___________________________________________________________________________



Telephone No:     Home: ______________________________ Business: ________________________



Email Address: ________________________________________________________________


Receive Monthly Newsletter through email:    Yes  No                 (Newsletter will be sent using email        unless otherwise specified)



Numismatic Topics of Interest:  _________________________________________________________




Mo. Num. Soc. Membership Sponsored by: ________________________________________________


Type of Application:                                               Family  /   Junior  (under 18 years)     (Please circle type)


Are you a former member? ______________              If so, what was your old number? ____________



I, ____________________________________________________ do solemnly pledge that I will exert my

                           Signature of Applicant        


influence and lend my aid to promote and advance every interest of the Missouri Numismatic Society: to uphold its by-laws and perform all imposed duties consistent with it and to attend meetings whenever possible. I further pledge that I will not cheat or defraud any one engaged in the hobby of Numismatics; that if I am accused thereof, and such charges are substantiated after due process of the applicable procedure established in the Society’s by-laws, it will be just cause for my expulsion from the Society.



Date of Application:      _____________________


Date Accepted:             _____________________         Number:  _________________________________                                                                                                                                         (For use of Secretary)                                 (For use of Secretary)



Send Application and check for $10.00 (for Family Membership) or $2.00 (for Junior Membership) to


Missouri Numismatic Society

P.O. Box 410652

St. Louis , MO 63141-0652


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