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National Token Collectors Association Membership Application

(please print your information below carefully)         (use your printer to print out and complete this application, then mail to address at bottom of page)

Name _________________________________________________________ Age ____________

Address ____________________________________________ Occupation ___________________

City _________________________________________ State ___________ Zip ________________

Telephone (home) __________________ (work) _____________ (Fax) ___________________

e-mail address ______________________________personal web site ________________________

Token collecting Interests(1) ________________________________________________________

(2)______________________________________________________________________________

(3) ______________________________________________________________________________

I hereby apply for membership in the National Token Collectors Association. I agree that if I am elected to membership I will abide by the Constitution and Bylaws of the National Token Collectors Association, and its Code of Ethics.

Date ________________ Signature ______________________________________________________

One year membership benefits include 12 issues of Talkin’ Tokens mailed by first class postage, a free classified ad up to a maximum of 50 words in each issue, and a permanent membership card.

Payment in US funds enclosed: One year Membership - $30.00    $_________________

                                                       Canadian Additional - $10.00   _________________

                                                Other Foreign Additional - $15.00  _________________

                                                                      Total Remittance -   _________________

Please do not write in the spaces below                                                                                                                        revised 13 feb 2004

Maill completed and signed application with check or money Referred by: ___Jerry Adams_______________________
Order in US funds made payable to National Token Collectors Membership No. Assigned _________________________
Association to: Date Received: _________________________________
Clark J. Rohmer, Secretary of NTCA Publications sent: ________________________________
P.O. BOX 281 Added to data base: __________________________
Ormond Beach, FL  32175 TT: ________________________________________
(904) 677-4206  

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