Membership Application

Membership Application
Tri City Coin Club

(PLEASE PRINT)

Date: ___________________________Phone Number: (_____)_______ -_________
Name: _____________________________________________________________________
Address: _________________________________________________________________
City:_____________________________ State:_______________ Zip:______________
E-mail:________________________________________________________________________

Interest (Check all that is applicable):

___ U S Coins ___ U S Paper Money

___ Foreign Coins ___ Ancient Coins
___ Confederate Paper ___ Foreign Paper

___ Tokens & Metals ___ Bank Notes

Other: Explain:

Sponsored By:_____Danita Archer____________________________________________
Accepted by:__________________________________________ Date:__________________

Annual Membership Dues
Adults - $5.00
Children (17 years and under) - $1.00
(Make checks payable to Tri City Coin Club)

Submit application along with membership dues to
Elizabeth M. Deeb, Treasurer
907 Forest View Drive
Colonial Heights, VA 23834

Tri City Coin Club Motto
“Do unto others as you would have them do unto you.”

How To Join

___	U S Coins	___	U S Paper Money
___	Foreign Coins	___	Ancient Coins
___	Confederate Paper	___	Foreign Paper
___	Tokens & Metals	___	Bank Notes