P.O.Box 29870, Tel Aviv, Israel, 61298

Fax: 972 3 5605001

E-mail: [email protected]

I hereby make application for membership of The society of Collectors of Bank Notes, Coins and Medals in Israel. I am aware of the Aims and Intentions of the Society and if I am accepted as a member, I undertake to abide by the rules and decisions made by the society's committee.

First Name ________________________ Last Name _________________________________

Phone ____________________________ Residential Address ____________________________________________________

______________________________________________________________________________________________________

Marrid/Single ______________________ Occupation ____________________________________________________________

Mailing Address _________________________________________________________________________________________

Email Address ___________________________________________________________________________________________

Date of Application _________________________ Signature of Applicant ______________________________

I enclose a check for annual membership amounting to US$ 35 drawn on a US bank.

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