The Australian Numismatic Society

Membership Application

Australian Numismatic Society.
P.O. Box 366, Brookvale, NSW 2100, Australia

E-Mail RodSell@RodSell.com

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

Joining fee A$5.00.
Membership fee A$25.00, Juniors under 16 A$12.50,
Overseas Members A$35 includes Airmail postage.
Payment can be made by A$ Cash, Cheque or Draft.
Overseas applicants please email Rod Sell and we can
arrange a safe payment method. Paypal if you have it.

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