Check type of membership for which you are applying: __ Individual (annual dues $10), __ Junior (annual dues $5) __ New __ Renewal Please type or print: Name: ________________________________________________________________ Address (optional if using e-mail): __________________________________________________________ City/State/ZIP: __________________________________________________________ Phone (with area code) (optional): __________________________________________ e-mail address (optional): _________________________________________________ Parent or Guardian (for juniors): ____________________________________________ Collecting Interest: ________________________________________ How did you hear about us? _________________________________ Signature _______________________________________________ I'd like to see the BCCOCO do the following: ___________________________________________________________________________ ___________________________________________________________________________ |