Membership Application
Please Print
Name:________________________________________________________
Home Address:_________________________________________________
City________________________________State_____Zip_______________
Home Phone(____)_____-_______
E-Mail Address:_________________________________________________
Birthday: Month________ Day_________ Year_____________
Dues: $5.00 Per Member
How did you here about us? ________________________________________
_______________________________________________________________
Signature: ______________________________________________________
Parent Signature (junior members only):_______________________________
Date____/____/_______
1st read: ___________ 2nd read: __________ Approved: __________________
Please make checks payable to Allentown Bethlehem Coin Club
Mail To:
Allentown and Bethlehem's Coin Club
P.O. Box 21187
Lehigh Valley, PA 18002-1187
For more information please