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:      _____________________

                                                                                         Membership

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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