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

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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   {__}3 Years...$42   {__}5 Years...$65   {__}Life Membership...$250
{__}Youth under 19...$7.50             {__}Associate...$7.50 (shares all mailings)
     I am enclosing $___________ as a donation for the OHNS scholarship program.

             2005 reprints of the Hobo Nickel Guidebook are available!
            They have a less elaborate cover than the original printing.
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       I am enclosing {__}$28.00 for the Hobo Nickel Guidebook by regular mail
                and {__}$2.00 additional for Priority Mail shipping.

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 Bill Fivaz
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    If your coin already has original QD papers and is being submitted for the next
           annual OHNS auction then please send it directly to Steve Alpert
                    because it does NOT need renewed QD processing.

                 Bill Fivaz, P.O.Box 888660, Dunwoody, GA 30356-0660
               Steve Alpert, P.O.Box 66331, Los Angeles, CA 90066-0331

    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 form for each coin submitted and
           mail coin(s), form(s) and payment to OHNS QD Examiner Bill Fivaz.

    For ADDITIONAL INSURANCE and/or REGISTERED MAIL: Please enclose an additional
  $5.00 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 $10.

    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 photograph of coin and {__}to use 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)... $________________
  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:   Wednesday, January 30, 2008