THE ORIGINAL HOBO NICKEL SOCIETY, Inc. ~  Membership and Quality Designation Services

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                Membership services - - - - send to the OHNS Secretary
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                OHNS, 12000 Sunset Ridge Drive, Ozawkie, KS 66070-6045

         Please {__}enroll or {__}renew me as a member in OHNS, as indicated.

      {__}1 Year...$15 (outside USA&Canada)...$30   {__}Youth (under 19)...$7.50*
           {__}Associate (shares all mailings)...$7.50*   {__}3 Years...$42*
                   {__}5 Years...$65*   {__}Life Membership...$250*
                                                                   * Inside USA only.
      I am enclosing $___________ as a donation for the OHNS scholarship program.

            2010 reprints of the Hobo Nickel Guidebook are now available!
         I am enclosing __$28* for the Hobo Nickel Guidebook by regular mail
                    and __$2 additional for Priority Mail shipping.
                                                               * OHNS Member pricing.
I agree to abide by the Society's Code of Ethics.


Signature___________________________ OHNS#________ Sponsor (optional)________________

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        Quality Designation services - - - send to OHNS QD Examiner Marc Banks
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                 Marc Banks, 11 Lincoln Lane, Weatogue, CT 06089-9781
             Steve Alpert, P.O.Box 335441, North Las Vegas, NV 89033-5441

    If your coin already has ORIGINAL QD papers and is being submitted for the next
  annual OHNS auction, then please send both the coin and the QD papers directly to
  Steve Alpert (without a QD Fee) because it does NOT need renewed QD processing.

    Submissions will be reviewed by two OHNS QD Examiners who will give independent
  opinions as to the quality of the carving (with explanation and/or observations),
  subject, and probable artist. A photograph of the coin will be taken to accompany
  the report.

    Originals of the report and photograph will be returned along with the coin to
  the owner and copies will be kept (1) by the first OHNS QD Examiner and (2) in
  the OHNS archives.

            Please fill out one of these forms for each coin submitted and
           mail coin(s), form(s) and payment to OHNS QD Examiner Marc Banks.

    For ADDITIONAL INSURANCE and/or REGISTERED MAIL: Please enclose an additional
  $5 per coin, per each additional $500 of insurance (or fraction thereof, up to a
  maximum of $25 for all coins submitted). If Registered Mail is desired on a single
  coin submission, add an additional $15.

    I understand the opinions rendered are strictly that, and are not a guarantee of
  value or authenticity. It is, however, the best considered judgment by qualified
  specialists in the field; but, others may reach different conclusions.

 I authorize OHNS to use {__}a photograph of my coin _and_ {__}my name (not address).

 I want this coin {__}RETURNED TO ME _or_ {__}PLACED IN THE NEXT ANNUAL OHNS AUCTION.


Owner's Signature______________________________________ OHNS#________ Date___________

OWNER'S VALUE OF COIN (NECESSARY FOR INSURANCE)... $_____________ <-MUST BE PROVIDED!
       Quality Designation Fees... $15 per coin; 10 or more coins @ $12.50 ea.;
                                   $25 per coin for non-members.
            Fee includes first class postage and $100 insurance per coin.

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                             Personal Contact information
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Name_______________________________ OHNS#________ Moniker (nickname)_________________

Address______________________________________________________________________________

City______________________________________________ State__________ ZIP_______________

Phone (optional)... Daytime________________________ Evenings_________________________

EMail address (optional)_____________________________________________________________
                            Please PRINT plainly... EMail is totally unforgiving!

          Please make all checks payable to... ORIGINAL HOBO NICKEL SOCIETY

               This form was last updated:     Saturday, July 16, 2011