C4 Application Form (Required For New Members Only) printable pdf download

C4 Application Form (Required For New Members Only)

C4 Application Form (required for

New

members only)

(for convenience, print out a hard copy to submit with your payment)

Name________________________________________________________

Address______________________________________________________

City__________________________________State_________Zip________

Email_________________________________________________________

I hereby apply for membership in the Colonial Coin Collectors Club.

Enclosed is $_____ in payment for dues.

Membership type:

____Regular $30.00 ($31.00/year if paying with PayPal)

____Junior (under 18 years of age) $10.00 (11.00/year if paying with PayPal)

____Regular outside of USA $40.00 ($41.00/year if paying with PayPal)

____Junior outside of USA (under 18 years of age) $15.00 (16.00/year if paying with PayPal)

Collecting interests:____________________________________________

____________________________________________________

How did you learn about C4?______________________________________

_____________________________________________________

Send check made payable to Colonial Coin Collectors Club or C4 to:

Charlie Rohrer ( )

C4 Treasurer

PO Box 25

Mountville, PA 17554

Or use

PayNow (PayPal)

button on this page to pay instantly. To use

PayPal

you

must already have a

PayPal

account. To use multiyear payment you must be a

member for at least one year.

C4 Application Form (Required For New Members Only)