EmailMe Form - Outreach Package Request Form

Club Name *

ANA Club Number *

Send Outreach Package to:

Name *

First Last

Contact person's email

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone *

### - ### - ####

Club Sponsored Show Information

Arrival Date for Outreach Package - You must request this outreach package at least 30 DAYS IN ADVANCE.

Name of Show *

First Date of Coin Show *

MM / DD / YYYY

Number of Attending Dealers *

Number of Expected Guests *

It is expected that the ANA information table will be staffed at least 75% of the time. If not, why?

Select an Outreach Package

Please select kit based on approximate show attendance:

Class A Outreach Package (1000+ Attendees): Up to 25 copies of The Numismatist, 25 membership applications, brochures and other promotional materials.

Class B Outreach Package (500+ Attendees): Up to 15 copies of The Numismatist, 15 membership applications, brochures and other promotional materials.

Class C Outreach Package (250+ Attendees) Up to 10 copies of The Numismatist, 10 membership applications, brochures and other promotional materials.