Worcester Mineral Club
P.O. Box 2278
Worcester, MA 01613
MEMBERSHIP APPLICATION
(PLEASE PRINT)
NAME:__________________________________________ .
ADDRESS: ______________________________________ .
CITY, STATE, ZIP_________________________________ .
HOME PHONE: __________________________________
WORK __________________________________________ .
E-MAIL: _________________________________________ .
Are you interested in minerals?_____ Fossils?_____ Gems?_____ Lapidary?_____
Earth Sciences?_____ Museum trips?_____ Collecting trips?_____
How you collected before? If yes, how long?__________
Please list any equipment/tools/resources you have for rockhounding:_________________
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Please list other interests, hobbies or special skills:_________________________________
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How did you hear about the club?_______________________________________________
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[ ] INDIVIDUAL MEMBERSHIP $8.00
[ ] FAMILY MEMBERSHIP $10.00
Names of other family members, including age if under 18
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Please accept my dues and application for membership in the Worcester Mineral Club, Inc.
Signed:____________________________________________Date:_____
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Send this completed application with dues made payable to the Worcester Mineral Club, Inc.
to the above address. Applications for membership will be voted on at the next regular club meeting, which you are welcome to attend.