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National Token Collectors Association MembershipApplication
(please print your information below carefully) (use your printer to print out and complete this application, then mail toaddress 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 NationalToken Collectors Association. I agree that if I am elected tomembership I will abide by the Constitution and Bylaws of the National Token CollectorsAssociation, and its Code of Ethics.
Date ________________ Signature______________________________________________________
One year membership benefits include 12issues of Talkin’ Tokensmailed by firstclass postage, a free classified ad up to a maximum of 50 words in each issue,and a permanentmembership card.
Payment in US funds enclosed: Oneyear Membership - $36.00 $_________________
Canadian Additional - $13.00 _________________
Other Foreign Additional - $18.00 _________________
Total Remittance - _________________
| 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 |
If you would like the 2009 NTCA membership directory it is an additional $9.00
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Please do not write in thespaces below revised 30 jan 2009
