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
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: _________________________________________________________
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