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RICHMOND COIN CLUB
APPLICATION FOR MEMBERSHIP
Club Meetings occur on the 1st Tuesday of each month
At Roma’s Restaurant, 8330 Staples Mill, Richmond, VA at 6:30 PM
To apply for membership, print and return your completed application with $5 in annual dues to:
Richmond Coin Club, PO Box 791, Glen Allen, VA 23060
Please make checks payable to: Richmond Coin Club
Name: _______________________________________________________________________
Address: _____________________________________________________________________
City: ______________________________________State: ___________ Zip: _____________
Home Phone: ______________ Work Phone: ____________ Cell Phone _________________
E-Mail Address: ______________________________________________________________
Company, if numismatic-related: ________________________________________________
Signature: _________________________________________Date:_______________________
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CLUB ACTIVITIES AND COMMITTEES YOU WOULD LIKE TO PARTICIPATE IN OR WOULD LIKE MORE INFORMATION ABOUT:
_____ COIN SHOW COMMITTEE _______ PROGRAM COMMITTEE
_____ YOUTH INVOLVEMENT _______ BOARD LEADERSHIP
COLLECTING INTERESTS: U.S. Coins ______ US Paper ______ Foreign Coins ______
Foreign paper ______ Ancient ______ Tokens ______ Confederate ______ Obsoletes _______
For Club Use Only:
SPONSORED BY:______________________________________________DATE_______________________
APPLICATION RECEIVED ON_________________________ VOTED IN ON _______________________
DUES RECEIVED: ___________________MEMBERSHIP #_________ CARD SENT:________________
ROSTER UPDATED:____________
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