Bend Coin Club of Central Oregon

BCCOCO is a non-profit organization.
Contact: Bend Coin Club of Central Oregon, e-mail
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Bend Coin Club of Central Oregon MEMBERSHIP APPLICATION

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:

Club use only:
Proposed by: ___________________________
Dues paid: $____________
Admission date: ____________
Membership # __________

Date of first reading: ____________
Date of second reading: ____________
Date approved: ____________