Membership Application

TURN IN TO THE TREASURER AT YOUR FIRST MEETING

ONE MEMBER FORM FOR EACH MEMBER

NAMEªªªªªªª

Dateªªªªªªªªªªªªª

Single or Family Membership

[       ] Single    [        ] Family

Amount paid

[       ] $10         [        ]$ 15

Birthdayªªªªªªªªªªª

Place of Birthªªªªªªªªª

Occupationªªªªªªªªªª

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Spouse’s/partner’s nameªªª

Partner’s Birthdayªªªªªª

Wedding anniversaryªªªªª

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Local addressªªªªªªªªª

Local phone numberªªªªª

Cell phone numberªªªªªª

E-mail addressªªªªªªªª

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Summer address if appropriate

Other phone numberªªªªª

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Children living at home

(date of birth)

Will children attend meetings?

[       ]yes    [      ]no

Circle the names of the children who will attend club meetings

Main interests in the club:

_____Bead Craft

_____Bench jeweler

_____Chain making

_____Collect fossils

_____Collect minerals

_____Facet gemstones

_____Gemologist

_____Goldsmith

_____Lapidary

_____Make cabochons

_____Metalwork

_____Sell fossils

_____Sell gemstones

_____Sell jewelry

_____Sell minerals

_____Sell rocks

_____Silversmith

_____Wire Crafter

Other:_________________________________________________________________________________________

___________________________________________________________________________________________

I WOULD BE INTERESTED IN LEARNING: ___________________________________________

I WOULD BE WILLING TO TEACH: __________________________________________________

I WOULD BE WILLING TO PRESENT A 15 TO 20 MINUTE PROGRAM ON:

__________________________________________________________________

Comments: on back

NAMEªªªªªªª
Dateªªªªªªªªªªªªª
Single or Family Membership	[ ] Single [ ] Family
Amount paid	[ ] $10 [ ]$ 15
Birthdayªªªªªªªªªªª
Place of Birthªªªªªªªªª
Occupationªªªªªªªªªª
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Spouse’s/partner’s nameªªª
Partner’s Birthdayªªªªªª
Wedding anniversaryªªªªª
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Local addressªªªªªªªªª
Local phone numberªªªªª
Cell phone numberªªªªªª
E-mail addressªªªªªªªª
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Summer address if appropriate
Other phone numberªªªªª
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Children living at home (date of birth)
Will children attend meetings?	[ ]yes [ ]no