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) ________________________________________________________
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: ________________________________________|
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