New Member Application

	What Are Die Varieties? New Member Application
	First Edition	May 2011	by James Wiles, Ph.D.
	New Member Application Today's Date: ______/______/______ Membership Type: _____ Regular/Annual Member - $25.00 _____ Young Numismatist (under 18) - $7.50 Mailing Options: _____ U.S. Bulk rate - No extra charge _____ First Class or Foreign - $12.50 additional Total: _____ Amount Due Name: _______________________________________________________ Address: _______________________________________________________ City: _______________________State: ______Zip + Four Code: __________ Phone: _______________________________________________________ E-mail: _______________________________________________________ Recommended by: What Are Die Varieties? Comments/Interests: ________________________________________________________________ ________________________________________________________________ Send application and check/money order (payable to CONECA) to: Rachel Irish 101 W. Prairie Center #323 Hayden, ID 83835 Your membership is subject to approval by the Membership Committee and subject to the rules and regulations set forth in the CONECA Constitution and By-Laws.
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Copyright James Wiles, 2011 Email: [email protected] 1490 Trail View Lane Frisco, TX 75034-2649