The Australian Numismatic Society

Membership Application

Australian Numismatic Society.
P.O. Box 830, Manly, NSW 1655, Australia

E-Mail RodSell@RodSell.com

Family Name.........................................................................
Given Names.........................................................................
Postal Address.......................................................................
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................................................................................................
Phone Number.......................................................................
Email Address........................................................................
Collecting Interests................................................................
Signed............................................Date........../........./...........

Membership fee A$40.00, Juniors under 16 A$20.00,
       Europe, Americas A$55 includes Airmail postage.
        NZ, Asia A$50 includes Airmail postage.
        Payment can be made by A$ Cash, Cheque or Draft.
        Overseas applicants please email Rod Sell and we can
        arrange a safe payment method.
        Paypal if you have it and pay their charges.

Administration Record
Application Received....................................................................
Application Approved...................................................................
Membership Number....................................................................
Applicant Notified................./.............../.................
Membership Kit sent................../................/................