Personal
Information:
Date of Application _________________
Your Name: First __________________ Initial ________ Family Name
________________________________
Spouse's Name: First __________________Initial _______ Family
Name_______________________________
Address:
___________________________________________________________________________________
City ________________________________ State ________ Zip Code
_____________Country ______________
Business Address (optional)
____________________________________________________________________
Phones: Home (______)__________________________ Work (optional) (_____)__________________________
Fax: Home
(______)___________________________ Work (optional) (_____)__________________________
Email Address:
Home____________________________ Work (optional)
________________________________
Web Site
___________________________________________________________________________________
Names of MBCA members whom you know:
______________________________________________________
___________________________________________________________________________________________
Name of your Sponsor:
________________________________ (please include his/her letter of
recommendation)
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
Mechanical Bank Collectors of America
P.O. Box 13323
Pittsburgh, PA 15243
Board of Directors Approval
____________________________________________ Date _____________________
|
Own five original
Mechanical
Banks. 
