MEMBERSHIP APPLICATION

THE AMERICAN SOCIETY OF CHECK COLLECTORS

MEMBERSHIP APPLICATION
The undersigned hereby applies for membership in the American Society of Check Collectors, Inc., and agrees to comply with its Charter and By-Laws

Enclosed with this application is $15 for dues ($20 for Canada and Mexico, $25 for other foreign countries, U.S. funds only.) Please make remittance payable to: The American Society of Check Collectors, Inc.

Name: ____________________________________________________________________________

Address: __________________________________________________________________________

City: ___________________________ State: _____ Zip: ____________ Country: ____________

E-mail address: ___________________________

New Application _____ Reinstatement ____

Collector ___ Collector/Dealer ___ Dealer ___

Signed: ________________________________________________ Date: ___________________

I found out about the ASCC through: ___________________________________________________

Please complete this form, enclose remittance for membership and mail to the Secretary:

Lyman Hensley, 473 East Elm, Sycamore, IL 60178, USA

Please circle the numbers that indicate your areas of collecting interest. This information will be listed with your name on our membership roster.

1. Checks, General 8. Travelers Checks and Money Orders

2. Checks, US 9. Specimen Checks

Region or States of Interest: 10. Ration Checks
_______________________________ 11. Refund/Rebate Checks

3. US Government Checks 12. Other _________________________________
4. Miscellaneous Fiscals 14. Counter and Modern Checks

Bank Drafts 20. Vignettes

Bills of Exchange 21. Autographs

Certificates of Deposit 22. Railroads, Steamboats, Mining
Promissory Notes 23. Banking History
Receipts 24. Security Printers and Printing
Warrants 25. Check Protectors and Cancel Device
5. Checks, Great Britian 26. Wells Fargo History
6. Checks, Canada 30. Stocks and Bonds
7. Checks, World 31. Revenue Stamped Documents
Region or Countries of Interest 32. Emergency Scrip
____________________________________

1. Checks, General	8. Travelers Checks and Money Orders
2. Checks, US	9. Specimen Checks
Region or States of Interest:	10. Ration Checks
_______________________________	11. Refund/Rebate Checks
3. US Government Checks	12. Other _________________________________
4. Miscellaneous Fiscals	14. Counter and Modern Checks
Bank Drafts	20. Vignettes
Bills of Exchange	21. Autographs
Certificates of Deposit	22. Railroads, Steamboats, Mining
Promissory Notes	23. Banking History
Receipts	24. Security Printers and Printing
Warrants	25. Check Protectors and Cancel Device
5. Checks, Great Britian	26. Wells Fargo History
6. Checks, Canada	30. Stocks and Bonds
7. Checks, World	31. Revenue Stamped Documents
Region or Countries of Interest	32. Emergency Scrip
____________________________________