Application for Membership

Personal Information

Name (please print):	_________________________________	Title:_______________
Address:	_____________________________________________________
City:	_________________________________	State:_______________
Zip:	_____________________________Country:_________________
E-mail:	_____________________________________________________

ACC/BHCC Bylaws require the publication of each applicant's name and state.

I herewith make application for membership in the ACC/BHCC subject to the Bylaws of said Club. I also agree to abide by the Code of Ethics adopted by the Club.

________________________________________	____________________
Signature of Applicant	Date

___________________________________________________________________
Signature of Parent or Guardian (required for applicant under the age of 18)

Payment Type

Check Money Order Cash

Types of Membership and Dues

1. Junior Membership (Under 18 years of age)	1 year	$12
2. Regular Membership	1 year	$39
3. Bronze Membership	3 years	$95
4. Silver Membership	5 years	$150
5. Gold Membership	10 years	$250
6. Platinum Membership	Lifetime	$450

Send Application together with your payment to Beverly Hills Coin Club, 9903 Santa Monica Blvd #951, Beverly Hills, CA 90212.