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