PRINT or DOWNLOAD APPLICATION HERE
Mid-GEORGIA Gem and Mineral Society Application for Membership
Name(s) __________________________________________________________________
__________________________________________________________________
Address___________________________________________________________________
City ____________________________________ State ________ Zip _____________
Phone___________________________________
E-mail Address ____________________________________________________________
List your interests and reasons for joining _________________________________
_____________________________________________________________________________
_____________________________________________________________________________
$15.00 ….. Adult (18-64)
$ 5.00 …… Junior
$10.00 …… Senior (65+)
$25.00 …… Family (2 adults and 2 children under 18)
Additional children $5.00
$10.00 …… Newsletter mailed $5.00
New Membership ________
Renewal _______________
Make checks payable to:
Mid-Georgia Gem & Mineral Society
Susan Hargrove, Treasurer
86 Clear Branch Road
Butler, Georgia 31006
Mail to the Treasurer or bring to a club meeting
Mid Georgia Gem and Mineral Society 