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Date of Application _________________
Name: First __________________ Initial ________ Last Name ________________________________
Spouse's Name: First __________________ Last Name_______________________________
Street Address:: ___________________________________________________________________________
City: ________________________________ State: ________ Zip Code: ____________Country: ___________
Cell Phone: (______)__________________________ Home Phone: (_____)__________________________
Email Address: __________________________________________________________________________
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: __________________________________________________________________
_________________________________________________________________________________________
Please forward your application and a check of $45.00 for the first year's membership dues payable to
the MBCA to the attention of:
Edwina Campbell
MBCA Secretary
1138 Moundview Ave
Newark, OH 43055
Questions: Contact Edwina at edwinacam@aol.com or 740-517-1063 (cell)
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Pay annual dues of $45.00 with a check payable to the MBCA.
