Tacoma-Lakewood Coin Club
MEMBERSHIP APPLICATION
PO Box 11192 - Tacoma, WA 98411
phone 253-565-6565, fax 253-851-8632
Also see application in PDF format (convenient to print)
Check type of membership for which you are applying:
__ Individual (annual dues $8)
__ Junior (annual dues $2)
__ NEW __ RENEWAL __ UPGRADE
Please type or
print:
Name: ________________________________________________________________
Address: ______________________________________________________________
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 TLCC do the following:
______________________________________________________________________
______________________________________________________________________
| TLCC use only: Proposed by: ________________________ Dues paid: $____________ Admission date: ____________ Membership # __________ |
Date of first reading: ____________ Date of second reading: ____________ Date approved: ____________ |
