Application for Membership In the Wichita Coin Club
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I herewith, make application for membership to the Wichita Coin Club, subject to the Constitution and Bylaws of the club.

Date:_________________________

Name:___________________________________

Address:___________________________________

City:_______________________________________

State:____________ Zip:___________________

Signature:_____________________________________

One year’s membership -- $10.00

Junior Membership -- $5.00
(12 & younger)

Wichita Coin Club
Box 884
Goddard, KS 67052