Application for Membership

Personal Information

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

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

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

Questions? Need Help? email info@bhcoinclub.org

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