MEMBERSHIP APPLICATION
  { click here for membership application in PDF format }

Requirement:   Pay annual dues of $45.00 with a check made payable to MBCA.

  Personal Information:                                                                    Date of Application _________________
 Your Name:  First __________________ Initial ________ Family Name ________________________________
 Spouse's Name:  First __________________Initial _______ Family Name_______________________________
 Address: ___________________________________________________________________________________
 City ________________________________ State ________ Zip Code _____________Country ______________
 Phones: Home (______)__________________________ Work (optional) (_____)__________________________
 Email Address: Home____________________________ Work (optional) ________________________________  
 Names of MBCA members whom you know: ______________________________________________________
 ___________________________________________________________________________________________


Additional Information:
 Are you (please circle one):           Collector                Dealer                Collector/Dealer
 Number of Mechanical Banks in your collection? __________________________________________________
 How many years have you been collecting?: _____________________________________________________    
 Other items that you collect: ____________________________________________________________________
Comments:
_________________________________________________________________________________
 ____________________________________________________________________________________________

                    Please forward your application together with a letter of recommendation, and a check
                    for the first year's membership dues payable to the MBCA to the attention of:

  
                    MBCA Secretary
                    Edwina Campbell
                    Mechanical Bank Collectors of America
                    1138 Moundview Ave
                    Newark, OH    43055 

                    edwinacam@aol.com 
                    740-517-1063 (mobile) 

  
Board of Directors Approval ____________________________________________  Date _____________________

 


                                                           
                                                       
                                                           

 

 

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