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APPLICATION FOR MEMBERSHIP TO WASHINGTON NUMISMATIC SOCIETY

Print this form, fill it out and send it to:

Washington Numismatic Society P.O. Box 9413 Washington, DC 20016

Name: _____________________________________________________________

Mailing Address: ____________________________________________________

City: ______________________________________ State: _____________ ZIP: ___________

Occupation: ____________________________________

Home Address: ______________________________________________________________

(if different from mailing address) ______________________________________________

Home Phone: ________________________ Business Phone: __________________________

E-mail: ______________________________

Collecting Specialty: ___________________________________________________________

Date: ______________________ Signature of Applicant: ____________________________

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