APPLICATION FOR MEMBERSHIP


NO.___________________________ DATE RECEIVED______________________________
(FOR USE BY THE SECRETARY)


SOUTH CAROLINA NUMISMATIC ASSOCIATION



MR.
MRS.
MISS________________________________________________________________________
                                               Full Name (Please Print)

Mailing Address________________________________________________________________

City/State/Zip Code_____________________________________________________________

Occupation____________________________________________________________________

Numismatic Specialty____________________________________________________________

Club or Society Membership______________________________________________________

Signature of Applicant_______________________________ Birth Date___________________

Signature of Proposer________________________________SCNA No.___________________

                               ANNUAL DUES: $10.00 ADULT * $5.00 JUNIOR

            Mail to:        SCNA Secretary
                               P.O. Box 693
                               Lugoff, SC 29078