EVERETT ROCK & GEM CLUB
Application for membership
Adult_________________________________________Birthday_______________
(month) (day)
Occupation________________________________Email______________________
Adult_________________________________________Birthday_______________
(month) (day)
Occupation________________________________Email______________________
Telephone___________________________Wedding Anniversary_______________
(month) (day)
Street____________________________City__________State______Zip_________
Youth Members 1.______________________________Birthday________________
(month) (day)
Yourth Address _________________________________________
Youth Phone __________________________________________
2.______________________________Birthday________________
(month) (day)
Yourth Address _________________________________________
Youth Phone __________________________________________
3.______________________________Birthday________________
(month) (day)
Yourth Address _________________________________________
Youth Phone __________________________________________
As a member of the Everett Rock & Gem Club, I agree to abide by the rules of the American Federation of Mineralogical Societies (AFMS) Code of Ethics.
As a member of the Everett Rock & Gem Club, I agree to abide by the Constitution and By-Laws of the Everett Rock & Gem Club.
I agree that the Everett Rock & Gem Club or its members shall not be held liable for any accident, injury, or loss to me or my family members while engaged in Everett Rock & Gem Club activities.
Annual dues: $20/Individual, $30/Couple, $7.50/Juniors (under 18 & with adult member) Includes name badge
Skills and Interest Survey:
Enjoy doing/Want to learn
Tumbling: _________ ___________
Cabochons: _________ ___________
Faceting: _________ ___________
Carving: _________ ___________
Jewelry Making: _________ ___________
Silver/Gold Smithing: _________ ___________
Mineral Collecting: _________ ___________
Fossil Collecting: _________ ___________
Club Organization Work: _________ ___________
Work with Juniors: _________ ___________
Skills I have:_______________________________________
Rock Equipment I have:______________________________
Signature:____________________Signature:____________________Date:_______
Everett Rock & Gem Club, PO Box 1615, Everett, WA 98206
Web Site: http://www.everettrockclub.com