Membership Application
To join TSNS, print this page, fill in information (please print), and send with
$10 yearly dues check to: Amy Kubicek, PO Box 2066, Douglasville, GA
30133. Questions email: Tsnsdues@gmail.com.
Name:
____________________________________________________________
______________
Business Name (if applicable):
_______________________________________________________
Telephone number: ___________________Email address:
_______________________
Street Address:
_____________________________City____________________
State_______ Zip___________
Birthdate ____________________ [Only required for Junior & Life (age
50+.]
Signature of Parent/Guardian for Junior members:
_______________________________________
Numismatic organizations of which you are a member:
______________________________

___Regular ($10.00/year) ___Regular ($25/three years)
___Life (ages 18-50) ($150.00) ___Life (ages 50+) ($75.00)
___Junior (under 18 years old) ($2.50/year)