MSNS Fall
09
Fall Convention & Coin Show
November 27, 28, 29, 2009
Hyatt Regency,
APPLICATION FOR BOURSE TABLE
Please sign and return immediately
NOTE: This
application must be accompanied by a $100 deposit made
payable to MSNS. Any forms received without the deposit will be returned and no
table reservation will be made. Be sure to sign and date below.
Dealership Name
_____________________________________________ MI Tax # __________________
Applicant Name
___________________________________ MSNS Member # __________________
Business Phone (___)
_________________ Fax (___) __________________ E-Mail Address_____________
(1) Assistant Name
___________________________ MSNS Member # _____________or New Member_____@
$10.00
Same as above_
or Address________________City___________ST______ZIP_____or
Renewal 2010_____@ $10.00
(2) Assistant Name
___________________________ MSNS Member # _____________or New Member_____@
$10.00
Same as above_or Address_________________City___________ST_______ZIP_____or
Renewal 2010____@ $10.00
No more than two assistants
are allowed per Bourse Table. All assistants must be current MSNS members in
good standing. Any assistant changes at the Convention can be made only after
Are you a member in good
standing of the American Numismatic Association? ___ Yes ___ NO
Have you ever been
suspended or expelled from the ANA? ___ Yes ___ No (It is MSNS
policy to refuse Bourse table space to any person who has been either suspended
or expelled by the ANA.)
This application may be canceled
and any payment refunded, if written
notice is given the
Bourse Chair at least 30 days prior to opening of the Convention; otherwise,
payment will be forfeited.
SHOWCASE RESERVATIONS: One case is free with each table, however, if not indicated,
no case will be provided.
Free case: ___ Yes ___ No Additional
cases at $10.00 each? __ (in addition to free case.)
TABLE LAMP RESERVATIONS: No table lamps are provided without cost. Table lamp rental
is $10.00 per lamp for the duration of the show. Number of lamps at $10.00
each: _____
Each dealer Bourse space has
one eight-foot table and complete backup facilities; no auxiliary or additional
tables are allowed. No wall signs allowed. Dealers are limited to the display
of no more than 25% non-numismatic items on the Bourse table. In the Annex
Room, this limit is 50%, but Annex tables are sold only after the main Bourse
is full.
I prefer the Main Room ____ or the Annex Room______.
DEALER WAIVER, RELEASE FROM LIABILITY
I hereby release the
Michigan State Numismatic Society, all participating clubs and their officers,
members, committees, agents and employees, in their official and/or individual
personal capacities, from any liability for loss, damage, or destruction,
through negligence or otherwise, of any numismatic material, and for personal
injury and property damage of any kind, which the undersigned may suffer or
incur before, during or after this Convention. The foregoing shall not,
however, limit the liability of any individual who may personally be guilty of
theft, willful damage or destruction.
The undersigned, in applying
for Bourse space, hereby agrees to accept the space allotted, and to abide by
all the rules and regulations of the Michigan State Numismatic Society, the
committees, the Hyatt Regency Hotel, the City of Dearborn and the State of
Michigan. I also will adhere to the MSNS code
of ethics.
Tables may NOT be
transferred, sold, leased, shared or sublet, in whole or in part, without
approval of the Bourse Chair. No dealer will be assigned more than one table
unless space is available. Dealer badges will be issued only to those listed
and any last-minute changes will be considered only after the official opening
of the Convention. Only those with Dealer badges and Assistant badges are
allowed behind a Bourse table.
Michigan State Numismatic Society reserves
the right to refuse a table to anyone or company for any reason without
liability, also we reserve the right to deny a dealer’s assistant credentials
to be behind the table. We also have the right to assign table
locations without recourse.
CAUTION: THIS APPLICATION CONTAINS A RELEASE FROM LIABILITY,
READ BEFORE SIGNING!
Signature of Applicant: _____________________________ Date
____________________
Mail this Application to:
PLEASE REPLY BEFORE:
Joseph H. Le Blanc,
Secretary/Treasurer
(734) 453-0504 FAX (734) 453
4475 jhl@michsoft.com
NOTE: ALL BOURSE AND MEETING AREAS ARE NON-SMOKING, AND
ALCOHOL IS PROHIBITED
Table Fee Main Room paid in
full before Aug. 1 Qty._________@ $350.00 =
__________
Table Fee Main Room after Aug. 1 Qty._________@
$375.00 = __________
Table Fee Annex Room paid in
full before Aug. 1 Qty.
_________@ $350.00 = __________
Table Fee Annex Room after Aug. 1 Qty._________@ $375.00 =
___________
Lamps Qty._________@ $10.00 = ___________
Cases
Free____
Qty._________@
$10.00 = ___________
Membership Reg._____
Qty._________@ $10.00 = ___________
Junior____ Qty._________@ $5.00
= ___________
Deposit Cash_____ Check
#_________ = (_________)
Balance due by
If not paid in full by
10/23/09 add an additional $25.00 service charge MSNS FALL 2009