THE
NEW
Membership form
MEMBER
NAME_______________________________________________BIRTHDAY____________
RELATED
ADULT______________________________________________BIRTHDAY____________
ADDRESS____________________________________________________________________________
CITY STATE
ZIP______________________________________________________________________
PHONE ( ____)______________WORK PHONE
(____)______________E-MAIL_______________
CHILDREN’S NAMES &
BIRTHDAYS___________________________________________________
_____________________________________________________________________________________
Do you want newsletter by ______________email_______________paper
SPECIAL INTERESTS (CIRCLE) : MINERAL LAPIDARY FOSSILS FACETING JEWELRY FIELD TRIPS
Willing to help by: (
) serve as officer ( )
serve on committee ( ) help with
the show
( ) presentation or
teaching ( )
study groups
( ) social functions (
) display work
How did you find out about
us________________________________________?
( ) SINGLE
MEMBERSHIP ( ) FAMILY MEMBERSHIP
ANNUAL DUES ARE $15 PER ADULT
$20 PER FAMILY + $1 per kid (AT ONE ADDRESS) January-December.
MAKE CHECKS PAYABLE TO CMS
SEND FORM TO: JUDY BUDNIK;
(CIRCLE ONE) CASH
CHECK $______________
Date ___________________
Date received______________________
Date approved as member_______________________