MEMBERSHIP APPLICATION FORM

To join the NBS, simply print the form below, fill it out and return along with a check or money order for your membership dues to:

Numismatic Bibliomania Society
David M. Sundman, Secretary/Treasurer NBS
P. O. Box 82
Littleton, NH 03561

YES, I would like to join the Numismatic Bibliomania Society. I understand that I will receive the Society's
quarterly journal  The Asylum.

Years	Standard U.S. Mail	U.S. lst Class	Outside of U.S.
1 Year	___$15.00	___$20.00	___$25.00
3 Years	___$45.00	___$60.00	___$75.00
Lifetime	___$300.00	___$400.00	___$500.00
Within the U.S., issues will be mailed U.S. Standard Mail, unless you select 1st Class delivery.

Please provide current address, phone & e-mail:

Name ________________________________________________

Street ________________________________________________

City _______________________________

State __________________________ Zip Code _______________

Phone ______________________Email  ____________________

I hereby make application for membership in the Numismatic Bibliomania Society, subject to the bylaws of the organization.

_____________________________________________________
     Signature of Applicant                         Date

Upon successfully joining the NBS, you will receive a valuable back issue of The Asylum - a collectible in its own right- and on publication, the current issue of The Asylum. Make all checks or money orders payable to: Numismatic Bibliomania Society

Return application with payment to:

NUMISMATIC BIBLIOMANIA SOCIETY (NBS)
David M. Sundman, Secretary/Treasurer NBS
P. O. Box 82
Littleton, NH 03561